Provider Demographics
NPI:1689743601
Name:TUSTIN HOSPITAL AND MEDICAL CENTER
Entity Type:Organization
Organization Name:TUSTIN HOSPITAL AND MEDICAL CENTER
Other - Org Name:NEWPORT SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/HOSPITAL CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-463-8273
Mailing Address - Street 1:14662 NEWPORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-619-7700
Mailing Address - Fax:949-732-4671
Practice Address - Street 1:14662 NEWPORT AVENUE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-619-7700
Practice Address - Fax:949-732-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30720FMedicaid
CAHSD30720FMedicaid
CAHSP40720FMedicaid
CAHSD30720FMedicaid