| Angel Fullerton Medical Group | |
|
1125 W Orangethorpe Ave Fullerton CA 92833-4735 | |
| (714) 870-1888 | |
| Not Available |
| Full Name | Angel Fullerton Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1125 W Orangethorpe Ave, Fullerton, California |
| Authorized Official Name and Position | Gerardo Canchola (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7146627710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Fullerton Medical Group 1125 W Orangethorpe Ave Fullerton CA 92833-4735 Ph: (714) 870-1888 | Angel Fullerton Medical Group 1125 W Orangethorpe Ave Fullerton CA 92833-4735 Ph: (714) 870-1888 |
| NPI Number | 1689271389 |
|---|---|
| Provider Enumeration Date | 10/06/2020 |
| Last Update Date | 10/06/2020 |
| Medicare PECOS PAC ID | 8022419126 |
|---|---|
| Medicare Enrollment ID | O20210722000425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689271389 | NPI | - | NPPES |
| 1639185879 | Other | CA | GENERAL PRACTICE |
| 1720399843 | Other | CA | GENERAL PRACTICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Gerardo Canchola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639185879 PECOS PAC ID: 0547210643 Enrollment ID: I20100628000844 |
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