Provider Demographics
NPI:1790004513
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:
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 STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1735
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:10918 HESPERIA RD STE B
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2151
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, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site