Healthcare Provider Details

I. General information

NPI: 1568495364
Provider Name (Legal Business Name): SOUTH COAST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S BRISTOL ST STE. 101-103
SANTA ANA CA
92704-5751
US

IV. Provider business mailing address

2650 S BRISTOL ST STE. 101-103
SANTA ANA CA
92704-5751
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-1444
  • Fax: 714-754-7009
Mailing address:
  • Phone: 714-754-1444
  • Fax: 714-754-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACOB WOLSZTEJN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-754-1444