Provider Demographics
NPI:1821115817
Name:SOUTH COAST FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:SOUTH COAST FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MINKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-800-1919
Mailing Address - Street 1:2650 S BRISTOL ST
Mailing Address - Street 2:105
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5751
Mailing Address - Country:US
Mailing Address - Phone:714-800-1919
Mailing Address - Fax:714-800-1924
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:105
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-800-1919
Practice Address - Fax:714-800-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX66720AMedicaid
CA00AX66720AMedicaid