Healthcare Provider Details

I. General information

NPI: 1689743601
Provider Name (Legal Business Name): TUSTIN HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14662 NEWPORT AVENUE
TUSTIN CA
92780
US

IV. Provider business mailing address

14662 NEWPORT AVENUE
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-7700
  • Fax: 949-732-4671
Mailing address:
  • Phone: 714-619-7700
  • Fax: 949-732-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. CLARA RUTH BLOM
Title or Position: VP/HOSPITAL CFO
Credential:
Phone: 310-463-8273