Provider Demographics
NPI:1184950073
Name:SOUTH COAST SURGICAL CARE, INC.
Entity type:Organization
Organization Name:SOUTH COAST SURGICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDIVIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-432-1438
Mailing Address - Street 1:PO BOX 28318
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-8318
Mailing Address - Country:US
Mailing Address - Phone:714-432-1438
Mailing Address - Fax:714-459-8280
Practice Address - Street 1:3420 BRISTOL ST
Practice Address - Street 2:SUITE 750
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7170
Practice Address - Country:US
Practice Address - Phone:714-432-1438
Practice Address - Fax:714-459-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical