# SOUTH COAST SPECIALTY SURGERY CENTER, INC.

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

## Provider details

- **NPI number:** 1932413176
- **Authorized official:** DR. HOMAN MAHALLATI D.O. (MEDICAL DIRECTOR)
- **Authorized official phone:** (714) 708-3737

## Contact information

- **Practice address:** 3420 BRISTOL ST, SUITE 750, COSTA MESA, CA 92626-7170
- **Practice address phone:** (714) 708-3737
- **Practice address fax:** (714) 708-3773
- **Mailing address:** 3420 BRISTOL ST, SUITE 750, COSTA MESA, CA 92626-7170
- **Mailing address phone:** (714) 708-3737
- **Mailing address fax:** (714) 708-3773

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 3919 | CA | Yes |

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 07/29/2010