Provider Demographics
NPI:1184985673
Name:SOUTH COAST DME
Entity type:Organization
Organization Name:SOUTH COAST DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-396-7807
Mailing Address - Street 1:19744 BEACH BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2988
Mailing Address - Country:US
Mailing Address - Phone:888-715-9990
Mailing Address - Fax:888-837-9990
Practice Address - Street 1:19744 BEACH BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2988
Practice Address - Country:US
Practice Address - Phone:888-715-9990
Practice Address - Fax:888-837-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA274709332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies