# COASTAL SURGERY CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083893572
- **Authorized official:** JIM SHAD R.N. (NURSE ADMINISTRATOR)
- **Authorized official phone:** (714) 841-4909

## Contact information

- **Practice address:** 17672 BEACH BLVD, SUITE B, HUNTINGTON BEACH, CA 92647-6836
- **Practice address phone:** (714) 841-4909
- **Practice address fax:** (714) 847-8587
- **Mailing address:** 16787 BEACH BLVD, SUITE 615, HUNTINGTON BEACH, CA 92647-4848
- **Mailing address phone:** (714) 843-9338
- **Mailing address fax:** (714) 843-6404

## Taxonomy

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

## Other

- **Enumeration date:** 10/31/2007
- **Last updated:** 10/31/2007