Healthcare Provider Details

I. General information

NPI: 1184950073
Provider Name (Legal Business Name): SOUTH COAST SURGICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 BRISTOL ST SUITE 750
COSTA MESA CA
92626-7170
US

IV. Provider business mailing address

PO BOX 28318
SANTA ANA CA
92799-8318
US

V. Phone/Fax

Practice location:
  • Phone: 714-432-1438
  • Fax: 714-459-8280
Mailing address:
  • Phone: 714-432-1438
  • Fax: 714-459-8280

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: LORENZA VALDIVIAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-432-1438