| Organization Name: | TUSTIN IRVINE MEDICAL GROUP, PC |
| NPI Number: | 1053576876 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH T MALLAS (ASSISTANT SECRETARY) |
| Mailing Address: | 25124 Springfield Ct Suite 200 Valencia |
| State: | CA US |
| Postal Code: | 913551085 |
| Phone Number: | 6616782600 |
| Fax Number: | 6616782700 |
| NPI Enumeration Date: | 07/21/2008 |
| NPI Last Update Date: | 02/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2083P0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Preventive Medicine |
| Taxonomy Specialization: | Preventive Medicine/Occupational Environmental Medicine |
| Taxonomy Definition: | A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |