| Organization Name: | SOUTH COAST OUTPATIENT SURGERY |
| NPI Number: | 1053545905 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL WAYNE NICCOLE (MEDICAL DIRECTOR) |
| Mailing Address: | 1101 Bayside Dr Suite 101 Corona Del Mar |
| State: | CA US |
| Postal Code: | 926251702 |
| Phone Number: | 9497186900 |
| Fax Number: | 9497189367 |
| NPI Enumeration Date: | 05/06/2009 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |