Provider Demographics
NPI:1801095427
Name:SOUTH COAST MEDICAL CENTER FOR NEW MED.INC
Entity type:Organization
Organization Name:SOUTH COAST MEDICAL CENTER FOR NEW MED.INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CONNEALY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:949-680-1907
Mailing Address - Street 1:55 VERNAL SPG
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0404
Mailing Address - Country:US
Mailing Address - Phone:949-680-1907
Mailing Address - Fax:
Practice Address - Street 1:6 HUGHES
Practice Address - Street 2:SUITE 100-150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2059
Practice Address - Country:US
Practice Address - Phone:949-680-1907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COAST MEDICAL CENTER FOR NEW MED. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
CABUS06-021662471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BUS06-02166OtherCITY OF IRVINE BUSINESS L
CAG57433OtherSTATE MEDICAL LICENSE
CAG57433OtherSTATE MEDICAL LICENSE
CAG57433OtherSTATE MEDICAL LICENSE