Healthcare Provider Details

I. General information

NPI: 1932076635
Provider Name (Legal Business Name): COASTLINE SURGERY CENTER OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

IV. Provider business mailing address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

V. Phone/Fax

Practice location:
  • Phone: 424-332-1574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. CHELSEA FIDAI
Title or Position: OWNER
Credential: MD
Phone: 424-332-1574