Provider Demographics
NPI:1003284258
Name:SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE, INC.
Entity Type:Organization
Organization Name:SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE, INC.
Other - Org Name:CENTER FOR NEW MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-680-1880
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1735
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:
Practice Address - Street 1:6 HUGHES STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2060
Practice Address - Country:US
Practice Address - Phone:949-680-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57433332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site