Basic Information
| Provider Information | |||||||||
| NPI: | 1235115874 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH COAST MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31872 COAST HWY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926516773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494991311 | ||||||||
| FaxNumber: | 9494997277 | ||||||||
| Practice Location | |||||||||
| Address1: | 31872 COAST HWY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926516773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494991311 | ||||||||
| FaxNumber: | 9494997277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9494991311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | CA | Y | Agencies | Home Health |
No ID Information.