Provider Demographics
NPI:1083736474
Name:SOUTH COAST PEDIATRICS
Entity Type:Organization
Organization Name:SOUTH COAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSZTEJN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-558-9393
Mailing Address - Street 1:1619 N SPURGEON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2328
Mailing Address - Country:US
Mailing Address - Phone:714-558-9393
Mailing Address - Fax:
Practice Address - Street 1:1619 N SPURGEON ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2328
Practice Address - Country:US
Practice Address - Phone:714-558-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty