1124314281 NPI number — SURGERY CENTER AT SOUTH COAST PLAZA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124314281 NPI number — SURGERY CENTER AT SOUTH COAST PLAZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER AT SOUTH COAST PLAZA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124314281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3420 BRISTOL ST
Provider Second Line Business Mailing Address:
SUITE 701
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-7170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-619-2658
Provider Business Mailing Address Fax Number:
855-885-2620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3420 BRISTOL ST
Provider Second Line Business Practice Location Address:
SUITE 701
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626-7170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-619-2658
Provider Business Practice Location Address Fax Number:
855-885-2620
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
HOANG
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
714-619-2650

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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