Provider Demographics
NPI:1427233667
Name:ABC MEDICAL GROUP, INC,, APC
Entity type:Organization
Organization Name:ABC MEDICAL GROUP, INC,, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-371-5800
Mailing Address - Street 1:650 E PARKRIDGE AVE
Mailing Address - Street 2:SUITTE 114 & 115
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1091
Mailing Address - Country:US
Mailing Address - Phone:951-371-5800
Mailing Address - Fax:951-371-5115
Practice Address - Street 1:650 E PARKRIDGE AVE
Practice Address - Street 2:SUITTE 114 & 115
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1091
Practice Address - Country:US
Practice Address - Phone:951-371-5800
Practice Address - Fax:951-371-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38530207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88020Medicare UPIN