Organization
TUSTIN HOSPITAL AND MEDICAL CENTER
Active
Other names
TUSTIN HOSPITAL AND MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
FAREED ENTEZAR PHARMD (PHARMACY DIRECTOR)
(714) 669-5874
Entity
Organization
Contact information
Practice address
14662 NEWPORT AVE, TUSTIN, CA 92780-6064
(714) 669-5874
(714) 669-2011
Mailing address
14662 NEWPORT AVE, TUSTIN, CA 92780-6064
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
HSP43375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0555322
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB433750
—
CA
05
—
PHB499750
—
CA
Enumeration date
04/02/2007
Last updated
02/18/2009
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