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NPI Code Detail

MEDICARE: ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.

MEDICARE: ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA37592CA

General Provider Information

NPI Number : 1306170279
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 11328 KENYON WAY STE B
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-9291
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 435 ORANGE SHOW LN STE 105
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-2015
Country : US
Telephone Number : 909-483-3530
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : EDUARDO ANGUIZOLA
Credential : MD
Telephone Number : 909-483-3530
Provider Enumeration Date : 09/25/2009
Last Update Date : 09/25/2009

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