Provider Demographics
NPI:1427103746
Name:ONE STOP MEDICAL GROUP,INC.
Entity type:Organization
Organization Name:ONE STOP MEDICAL GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WETTACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-8050
Mailing Address - Street 1:2179 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1346
Mailing Address - Country:US
Mailing Address - Phone:408-258-8050
Mailing Address - Fax:408-258-8180
Practice Address - Street 1:2179 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1346
Practice Address - Country:US
Practice Address - Phone:408-258-8050
Practice Address - Fax:408-258-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31903207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03624ZMedicare ID - Type UnspecifiedGROUP ID