Provider Demographics
NPI:1407000250
Name:ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
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:909-483-3530
Mailing Address - Street 1:11328 KENYON WAY STE B
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9291
Mailing Address - Country:US
Mailing Address - Phone:909-483-3530
Mailing Address - Fax:909-483-3423
Practice Address - Street 1:11328 KENYON WAY STE B
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9291
Practice Address - Country:US
Practice Address - Phone:909-483-3530
Practice Address - Fax:909-483-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty