Organization
SOUTH COAST OUTPATIENT SURG CTR BALBOA SURGERY CENTER
Active
Other names
SOUTH COAST OUTPATIENT SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WAYNE NICCOLE M.D. (MEDICAL DIRECTOR)
(310) 792-3914
Entity
Organization
Contact information
Practice address
1101 BAYSIDE DR, SUITE 101, CORONA DEL MAR, CA 92625-1702
(949) 718-6900
(949) 718-9367
Mailing address
1101 BAYSIDE DR STE 100, CORONA DEL MAR, CA 92625-1754
(949) 718-6900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F1929
PTAN
CA
Enumeration date
05/06/2009
Last updated
10/30/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us