# SOUTH COAST SPINE AND WELLNESS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OC Family Medicine and Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568736304
- **Authorized official:** DR. VICTORIA CUPIC M.D. (VICE PRESIDENT)
- **Authorized official phone:** (949) 488-9600

## Contact information

- **Practice address:** 26841 CALLE HERMOSA, SUITE A, CAPISTRANO BEACH, CA 92624-1674
- **Practice address phone:** (949) 488-9600
- **Practice address fax:** (949) 488-9601
- **Mailing address:** 26841 CALLE HERMOSA, SUITE A, CAPISTRANO BEACH, CA 92624-1674
- **Mailing address phone:** (949) 488-9600
- **Mailing address fax:** (949) 488-9601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NS0005X | Sports Physician Chiropractor | — | NULL | — |
| 111NS0005X | Sports Physician Chiropractor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2012
- **Last updated:** 02/28/2012