Provider Demographics
NPI:1568736304
Name:SOUTH COAST SPINE AND WELLNESS INC
Entity Type:Organization
Organization Name:SOUTH COAST SPINE AND WELLNESS INC
Other - Org Name:OC FAMILY MEDICINE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-488-9600
Mailing Address - Street 1:26841 CALLE HERMOSA
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1674
Mailing Address - Country:US
Mailing Address - Phone:949-488-9600
Mailing Address - Fax:949-488-9601
Practice Address - Street 1:26841 CALLE HERMOSA
Practice Address - Street 2:SUITE A
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1674
Practice Address - Country:US
Practice Address - Phone:949-488-9600
Practice Address - Fax:949-488-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty