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General NPI Number Information
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NPI Number | 1891860748
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Entity Type | Organization
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Legal Business Name | SOUTH COAST PEDIATRICS
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1720 W BALL RD STE.#1
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City | ANAHEIM
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State | CA
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Zip | 92804-5500
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Country | US
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Telephone | 714-991-5141
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Fax | 714-991-5144
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Provider Business Mailing Address
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Address Line | 1720 W BALL RD STE.#1
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City | ANAHEIM
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State | CA
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Zip | 92804-5500
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Country | US
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Telephone | 714-991-5141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB WOLSZTEJN
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Credential | M.D.
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Telephone | 714-991-5141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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