MEDICARE: ONE STOP 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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	C31903	CA

General Provider Information

NPI Number	:	1427103746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE STOP MEDICAL GROUP,INC.

Provider Business Mailing Address
First Line	:	2179 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:	408-258-8050
Fax Number	:	408-258-8180

Provider Business Practice Location Address
First Line	:	2179 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:	408-258-8050
Fax Number	:	408-258-8180

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. GEORGE E. WETTACH
Credential	:	M.D.
Telephone Number	:	408-258-8050

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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