Provider Demographics
NPI:1932413176
Name:SOUTH COAST SPECIALTY SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH COAST SPECIALTY SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHALLATI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-708-3737
Mailing Address - Street 1:3420 BRISTOL ST
Mailing Address - Street 2:SUITE 750
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7170
Mailing Address - Country:US
Mailing Address - Phone:714-708-3737
Mailing Address - Fax:714-708-3773
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:714-708-3737
Practice Address - Fax:714-708-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3919261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical