Healthcare Provider Details

I. General information

NPI: 1346559879
Provider Name (Legal Business Name): HOAG URGENT CARE TUSTIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 BRYAN AVE SUITE A
TUSTIN CA
92782-8922
US

IV. Provider business mailing address

18231 IRVINE BLVD STE 204
TUSTIN CA
92780-3432
US

V. Phone/Fax

Practice location:
  • Phone: 714-389-3500
  • Fax: 714-389-6500
Mailing address:
  • Phone: 714-389-5700
  • Fax: 714-389-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG34265
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberG34265
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberG34265
License Number StateCA

VIII. Authorized Official

Name: MRS. JENNIFER ERICA AMSTER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 714-389-3500