Healthcare Provider Details

I. General information

NPI: 1083736474
Provider Name (Legal Business Name): SOUTH COAST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 N SPURGEON ST
SANTA ANA CA
92701-2328
US

IV. Provider business mailing address

1619 N SPURGEON ST
SANTA ANA CA
92701-2328
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-9393
  • Fax:
Mailing address:
  • Phone: 714-558-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB WOLSZTEJN
Title or Position: OWNER
Credential: MD
Phone: 714-558-9393