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General NPI Number Information
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NPI Number | 1306170279
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Entity Type | Organization
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Legal Business Name | ONE STOP MULTI-SPECIALTY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 435 ORANGE SHOW LN STE 105
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2015
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Country | US
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Telephone | 909-483-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 11328 KENYON WAY STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-9291
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EDUARDO ANGUIZOLA
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Credential | MD
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Telephone | 909-483-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A37592
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License Number State | CA
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