Metabolic Medicine & Fitness Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

A78428B Issued in CA

Legal business name

METABOLIC MEDICINE & FITNESS CENTER

Practice address

17542 17TH St
Suite 410
Tustin, CA 92780-1959

Phone

(714) 541-4343

Fax

(714) 835-9550

NPI assigned

Apr 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eric H. Pham, M.D.

Title

Medica Doctor/ Owner

Phone

(714) 541-4343

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1356738769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17542 17TH ST",
            "address_2": "SUITE 410",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801959",
            "telephone_number": "714-541-4343",
            "fax_number": "714-835-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17542 17TH ST",
            "address_2": "SUITE 410",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801959",
            "telephone_number": "714-541-4343",
            "fax_number": "714-835-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METABOLIC MEDICINE & FITNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "MEDICA DOCTOR/ OWNER",
        "authorized_official_telephone_number": "714-541-4343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "A78428B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Tustin, CA
• Providers in Tustin, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.