# SOUTH COAST OUTPATIENT SURG CTR BALBOA SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTH COAST OUTPATIENT SURGERY CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053545905
- **Authorized official:** DR. MICHAEL WAYNE NICCOLE M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 792-3914

## Contact information

- **Practice address:** 1101 BAYSIDE DR, SUITE 101, CORONA DEL MAR, CA 92625-1702
- **Practice address phone:** (949) 718-6900
- **Practice address fax:** (949) 718-9367
- **Mailing address:** 1101 BAYSIDE DR STE 100, CORONA DEL MAR, CA 92625-1754
- **Mailing address phone:** (949) 718-6900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | CA | Yes |

## Other

- **Enumeration date:** 05/06/2009
- **Last updated:** 10/30/2018