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General NPI Number Information
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NPI Number | 1902700180
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Entity Type | Organization
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Legal Business Name | SOUTH COAST WELLNESS INC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 151 KALMUS DR STE A104
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City | COSTA MESA
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State | CA
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Zip | 92626-5900
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Country | US
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Telephone | 949-220-0850
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Fax |
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Provider Business Mailing Address
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Address Line | 151 KALMUS DR STE A104
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City | COSTA MESA
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State | CA
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Zip | 92626-5900
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Country | US
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Telephone | 949-220-0850
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | AMY LYNN ELLSWORTH
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Credential | RDN
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Telephone | 949-220-0850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | NULL
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