NPIMap

Organization Active NPI

Tustin Hospital and Medical Center

  • Long Term Care Pharmacy
  • Tustin, CA
National Provider Identifier
1578684395
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
HSP43375 Issued in CA
Legal business name
TUSTIN HOSPITAL AND MEDICAL CENTER
Doing business as
Tustin Hospital and Medical Center
Practice address
14662 Newport Ave
Tustin, CA 92780-6064
Phone
(714) 669-5874
Fax
(714) 669-2011
NPI assigned
Apr 2, 2007
Last updated
Feb 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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

Authorized official

Name
Fareed Entezar, PHARMD
Title
Pharmacy Director
Phone
(714) 669-5874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X HSP43375 CA Primary

Addresses

Primary practice location

14662 Newport Ave
Tustin, CA 92780-6064

Mailing address

14662 Newport Ave
Tustin, CA 92780-6064

Other identifiers 3

IdentifierTypeStateIssuer
PHB433750MedicaidCA
PHB499750MedicaidCA
0555322OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • TUSTIN HOSPITAL AND MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tustin Hospital and Medical Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1578684395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14662 NEWPORT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14662 NEWPORT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806064",
            "telephone_number": "714-669-5874",
            "fax_number": "714-669-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUSTIN HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "ENTEZAR",
        "authorized_official_first_name": "FAREED",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "714-669-5874",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "HSP43375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHB433750",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHB499750",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0555322",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TUSTIN HOSPITAL AND MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; 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.