Angel Fullerton Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ANGEL FULLERTON MEDICAL GROUP

Practice address

1125 W Orangethorpe Ave
Fullerton, CA 92833-4735

Phone

(714) 870-1888

NPI assigned

Oct 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gerardo Canchola, MDNPI 1639185879

Title

Medical Director

Phone

(714) 662-7710

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerardo Canchola, M.D.

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1639185879
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1689271389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 W ORANGETHORPE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334735",
            "telephone_number": "714-870-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 W ORANGETHORPE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334735",
            "telephone_number": "714-870-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL FULLERTON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "CANCHOLA",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "714-662-7710",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL PRACTICE",
            "identifier": "1639185879",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL PRACTICE",
            "identifier": "1720399843",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "internal",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1125 W Orangethorpe Ave",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928334735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gabriela Alejandra Andrade
• Jessica Andrade
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• Trinity-Nevaeh Andrews
• Angau LLC
• Kamarah Angeles
• Quiriana Angeles
• Laura Noriko Anghelus, NP
• Chioma C Aniagba
• Anjana a.Patel,DDS.,Inc

• Primary Care Clinic/Center in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.