Organization
SOUTH COAST SPECIALTY SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOMAN MAHALLATI D.O. (MEDICAL DIRECTOR)
(714) 708-3737
Entity
Organization
Contact information
Practice address
3420 BRISTOL ST, SUITE 750, COSTA MESA, CA 92626-7170
(714) 708-3737
(714) 708-3773
Mailing address
3420 BRISTOL ST, SUITE 750, COSTA MESA, CA 92626-7170
(714) 708-3737
(714) 708-3773
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
3919
CA
Other
Enumeration date
07/29/2010
Last updated
07/29/2010
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