Healthcare Provider Details

I. General information

NPI: 1205120375
Provider Name (Legal Business Name): PACIFIC RHEUMATOLOGY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 EDINGER AVE STE 130
TUSTIN CA
92780-6298
US

IV. Provider business mailing address

1422 EDINGER AVE STE 130
TUSTIN CA
92780-6298
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-9342
  • Fax: 714-628-9759
Mailing address:
  • Phone: 714-628-9342
  • Fax: 714-628-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC54349
License Number StateCA

VIII. Authorized Official

Name: BEHNAM KHALEGHI
Title or Position: MD/OWNER
Credential: MD
Phone: 949-292-4031