MEDICARE: SOUTH COAST SURGERY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1720794928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	2621 ZOE AVE STE B
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4131
Country	:	US
Telephone Number	:	323-749-6644
Fax Number	:	562-200-0181

Provider Business Practice Location Address
First Line	:	2621 ZOE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4131
Country	:	US
Telephone Number	:	714-699-8363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABTIN RAHIMIAN
Credential	:	DDS
Telephone Number	:	714-699-6838

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	06/24/2024

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