South Coast Outpatient Surg Ctr Balboa Surgery Center
NPI #1053545905 in Corona Del Mar, California
Provider Information
- NPI Number
- 1053545905
- Entity Type
- Organization
- Organization Name
- South Coast Outpatient Surg Ctr Balboa Surgery Center
- Primary Specialty
- Clinic/Center - Ambulatory Surgical
- Enumeration Date
- May 6, 2009
- Last Updated
- Oct 30, 2018
Practice Location
- Address
- 1101 BAYSIDE DR
- Address 2
- SUITE 101
- City
- Corona Del Mar
- State
- California
- ZIP Code
- 92625-1702
- Phone
- (949) 718-6900
Authorized Official
- Name
- DR. MICHAEL WAYNE NICCOLE, M.D.
- Title
- MEDICAL DIRECTOR
- Phone
- (310) 792-3914
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Ambulatory Surgical — Ambulatory Surgical |
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