Provider Demographics
NPI:1740608678
Name:ONESTOP MULTI SPECIALTY MEDICAL GROUP AND THERAPY
Entity Type:Organization
Organization Name:ONESTOP MULTI SPECIALTY MEDICAL GROUP AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
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:877-882-9832
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:877-882-9832
Mailing Address - Fax:
Practice Address - Street 1:435 ORANGE SHOW LN STE 104
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2015
Practice Address - Country:US
Practice Address - Phone:877-882-9832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28576111NX0800X
CADC29308111NX0800X
CAA37952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty