Provider Demographics
NPI:1033389408
Name:RANCHO INDUSTRIAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RANCHO INDUSTRIAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANGUIZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-350-7208
Mailing Address - Street 1:14384 SLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7122
Mailing Address - Country:US
Mailing Address - Phone:909-350-7208
Mailing Address - Fax:909-350-7209
Practice Address - Street 1:14384 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7122
Practice Address - Country:US
Practice Address - Phone:909-350-7208
Practice Address - Fax:909-350-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27592111N00000X
CAA37952174400000X
CAG39074174400000X
CA18783363AM0700X
CA20771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty