Healthcare Provider Details

I. General information

NPI: 1891939351
Provider Name (Legal Business Name): SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE,.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HUGHES SUITE 100
IRVINE CA
92618-2059
US

IV. Provider business mailing address

6 HUGHES SUITE 100
IRVINE CA
92618-2059
US

V. Phone/Fax

Practice location:
  • Phone: 949-680-1880
  • Fax: 949-680-1919
Mailing address:
  • Phone: 949-680-1880
  • Fax: 949-680-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20A11028
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG57433
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHF75256
License Number StateCA

VIII. Authorized Official

Name: DR. LEIGH ERIN CONNEALY
Title or Position: PRESIDENT
Credential:
Phone: 949-680-1880