Healthcare Provider Details

I. General information

NPI: 1346569167
Provider Name (Legal Business Name): ONE STOP MULIT SPECIALTY MEDICAL GROUP, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81557 DOCTOR CARREON BLVD STE B5
INDIO CA
92201-5562
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR STE 301
LOS ANGELES CA
90077-1735
US

V. Phone/Fax

Practice location:
  • Phone: 909-483-3530
  • Fax:
Mailing address:
  • Phone: 310-474-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO ANGUIZOLA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-483-3530