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General NPI Number Information
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NPI Number | 1427233667
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Entity Type | Organization
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Legal Business Name | ABC MEDICAL GROUP, INC,, APC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 650 E PARKRIDGE AVE SUITTE 114 & 115
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City | CORONA
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State | CA
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Zip | 92879-1091
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Country | US
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Telephone | 951-371-5800
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Fax | 951-371-5115
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Provider Business Mailing Address
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Address Line | 650 E PARKRIDGE AVE SUITTE 114 & 115
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City | CORONA
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State | CA
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Zip | 92879-1091
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Country | US
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Telephone | 951-371-5800
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Fax | 951-371-5115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEFAN JONATHAN ORR
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Credential | M.D.
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Telephone | 951-371-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C38530
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C38530
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License Number State | CA
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