Provider Demographics
NPI:1568495364
Name:SOUTH COAST PEDIATRICS
Entity Type:Organization
Organization Name:SOUTH COAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:714-754-1444
Mailing Address - Street 1:2650 S BRISTOL ST
Mailing Address - Street 2:STE. 101-103
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5751
Mailing Address - Country:US
Mailing Address - Phone:714-754-1444
Mailing Address - Fax:714-754-7009
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:STE. 101-103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-754-1444
Practice Address - Fax:714-754-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty