Provider Demographics
NPI:1053657080
Name:ONE STOP MULTI SPECIALTY MEDICAL GROUP AND THERAPY
Entity Type:Organization
Organization Name:ONE STOP MULTI SPECIALTY MEDICAL GROUP AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGUIZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-483-3530
Mailing Address - Street 1:575 ANTON BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7169
Mailing Address - Country:US
Mailing Address - Phone:909-483-3530
Mailing Address - Fax:909-380-7741
Practice Address - Street 1:575 ANTON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7169
Practice Address - Country:US
Practice Address - Phone:909-483-3530
Practice Address - Fax:909-380-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain