Provider Demographics
NPI:1639523905
Name:SOUTH COAST ORTHOPEDICS
Entity Type:Organization
Organization Name:SOUTH COAST ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-508-4123
Mailing Address - Street 1:18102 IRVINE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3402
Mailing Address - Country:US
Mailing Address - Phone:714-508-4123
Mailing Address - Fax:714-508-4134
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3650
Practice Address - Country:US
Practice Address - Phone:714-508-4123
Practice Address - Fax:714-508-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty