MEDICARE: SOUTH COAST PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		CA

General Provider Information

NPI Number	:	1568495364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST PEDIATRICS

Provider Business Mailing Address
First Line	:	2650 S BRISTOL ST
Second Line	:	STE. 101-103
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5751
Country	:	US
Telephone Number	:	714-754-1444
Fax Number	:	714-754-7009

Provider Business Practice Location Address
First Line	:	2650 S BRISTOL ST
Second Line	:	STE. 101-103
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5751
Country	:	US
Telephone Number	:	714-754-1444
Fax Number	:	714-754-7009

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACOB WOLSZTEJN
Credential	:	M.D.
Telephone Number	:	714-754-1444

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	12/08/2011

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Directions to “SOUTH COAST PEDIATRICS ” Practice Location

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