Healthcare Provider Details

I. General information

NPI: 1124314281
Provider Name (Legal Business Name): SURGERY CENTER AT SOUTH COAST PLAZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 BRISTOL ST SUITE 701
COSTA MESA CA
92626-7170
US

IV. Provider business mailing address

3420 BRISTOL ST SUITE 701
COSTA MESA CA
92626-7170
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-2658
  • Fax: 855-885-2620
Mailing address:
  • Phone: 714-619-2658
  • Fax: 855-885-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOANG LOUIS NGUYEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-619-2650