Healthcare Provider Details

I. General information

NPI: 1740266394
Provider Name (Legal Business Name): SOUTH COAST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-1311
  • Fax: 949-499-7277
Mailing address:
  • Phone: 949-499-1311
  • Fax: 949-499-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: JANET BAKER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 949-499-1311