MEDICARE: ONE STOP MULIT 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
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

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

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR STE 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1735
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	81557 DOCTOR CARREON BLVD STE B5
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5562
Country	:	US
Telephone Number	:	909-483-3530
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	EDUARDO ANGUIZOLA
Credential	:	M.D.
Telephone Number	:	909-483-3530

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	03/01/2011

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