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SOUTH COAST OUTPATIENT SURGERY CENTER
NPI 1053545905
Clinic/Center - Ambulatory Surgical in Corona Del Mar, CA

Active since May 06, 2009CLIA 05D1092781 · Waiver
1101 BAYSIDE DR, SUITE 101, CORONA DEL MAR, CA 92625(949) 718-6900(949) 718-9367 Get Directions Write a Review

NPPES record last updated: October 30, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About South Coast Outpatient Surgery Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH COAST OUTPATIENT SURGERY CENTER (NPI 1053545905) is a healthcare organization registered as an ambulatory surgical in Corona Del Mar, California and active in the NPI registry since May 2009. The organization holds a CLIA Waiver certificate valid through May 9, 2028 and lists Michael Wayne Niccole, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1053545905
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSOUTH COAST OUTPATIENT SURG CTR BALBOA SURGERY CENTER
Location Address1101 BAYSIDE DR, SUITE 101Corona Del Mar, CA 92625-1702
Mailing Address1101 Bayside Dr Ste 100Corona Del Mar, CA 92625-1754 · (949) 718-6900
Phone(949) 718-6900
Fax(949) 718-9367
Organization SubpartNo
Authorized OfficialMichael Wayne NiccoleMedical Director · (310) 792-3914
Enumeration DateMay 6, 2009
Last NPPES UpdateOctober 30, 2018
✔ NPI 1053545905 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1101 BAYSIDE DR, Corona Del Mar, CA 92625
Open in Google Maps ↗

Other Names 1

Doing Business AsSouth Coast Outpatient Surgery Center

Other Identifiers 1

OtherF1929CA · Ptan

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1092781

South Coast Outpatient Surgery Center · Corona Del Mar, CA
Active · expires May 9, 2028
CLIA Number05D1092781
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateMay 10, 2026
Certificate Expiration DateMay 9, 2028
Laboratory DirectorNiccole Michael
Laboratory Phone(949) 999-8644
Laboratory LocationSouth Coast Outpatient Surgery Center1101 Bayside Dr, Ste 100, Corona Del Mar, CA 92625
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL W. NICCOLE, MD, INC.
Specialist
1101 BAYSIDE DR, SUITE 100
CORONA DEL MAR, CA 92625
Orange County (949) 718-6900
HANS JORG ROSLER MD LLC
Pain Medicine (Pain Medicine)
1101 BAYSIDE DR, SUITE 100
CORONA DEL MAR, CA 92625
Orange County (702) 357-8004
KATHERINE MACBARRON
Physician Assistant
1101 BAYSIDE DR
CORONA DEL MAR, CA 92625
Orange County (949) 718-6900
PLASTIC SURGERY GROUP, A MEDICAL CORPORATION
Specialist
1101 BAYSIDE DR, SUITE 100
CORONA DEL MAR, CA 92625
Orange County (949) 718-6900
DR. STEPHEN SUTHERLAND M.D.
Surgery (Plastic and Reconstructive Surgery)
1101 BAYSIDE DR, STE. 100
CORONA DEL MAR, CA 92625
Orange County (949) 718-6900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Coast Outpatient Surg Ctr Balboa Surgery Center's NPI number?

The NPI number for South Coast Outpatient Surg Ctr Balboa Surgery Center is 1053545905. It was assigned to this organization in the NPPES registry on May 6, 2009. The provider is doing business as South Coast Outpatient Surgery Center.

Where is South Coast Outpatient Surg Ctr Balboa Surgery Center located?

South Coast Outpatient Surg Ctr Balboa Surgery Center is located at 1101 Bayside Dr Suite 101, Corona Del Mar, CA 92625. The listed phone number is (949) 718-6900.

What is South Coast Outpatient Surg Ctr Balboa Surgery Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does South Coast Outpatient Surg Ctr Balboa Surgery Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1092781) is associated with this NPI, valid through May 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for South Coast Outpatient Surg Ctr Balboa Surgery Center was last updated on October 30, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.