Provider Demographics
NPI:1619381530
Name:ONE STOP MULTI-SPECIALTY MEDICAL GROUP & THERAPY, INC.
Entity Type:Organization
Organization Name:ONE STOP MULTI-SPECIALTY MEDICAL GROUP & THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
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 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:10399 LEMON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3770
Practice Address - Country:US
Practice Address - Phone:909-483-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE STOP MULTI-SPECIALTY MEDICAL GROUP & THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37952332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site