Provider Demographics
NPI:1902003791
Name:SOUTH COAST FAMILY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTH COAST FAMILY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:949-643-8921
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7373
Mailing Address - Country:US
Mailing Address - Phone:949-643-8921
Mailing Address - Fax:949-643-3914
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7373
Practice Address - Country:US
Practice Address - Phone:949-643-8921
Practice Address - Fax:949-643-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37009261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952335598OtherNPI MICHAEL KENT MD
CAA37009OtherBLUE CROSS LICENSE
CAZZZ26875ZOtherBLUE SHIELD
CAZZZ26875ZOtherBLUE SHIELD