Healthcare Provider Details

I. General information

NPI: 1811059223
Provider Name (Legal Business Name): TUSTIN HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14662 NEWPORT AVE
TUSTIN CA
92780-6064
US

IV. Provider business mailing address

14662 NEWPORT AVE
TUSTIN CA
92780-6064
US

V. Phone/Fax

Practice location:
  • Phone: 714-669-5874
  • Fax:
Mailing address:
  • Phone: 714-669-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHSP43375
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberHSP43375
License Number StateCA

VIII. Authorized Official

Name: AIMAN AHDAB
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 714-669-5874