ANGEL FULLERTON MEDICAL GROUP
NPI 1689271389
Clinic/Center - Primary Care in Fullerton, CA
About Angel Fullerton Medical Group NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ANGEL FULLERTON MEDICAL GROUP (NPI 1689271389) is a healthcare organization registered as a primary care in Fullerton, California and active in the NPI registry since October 2020. The organization holds a CLIA Waiver certificate valid through September 21, 2028 and lists Gerardo Canchola, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Angel Fullerton Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Angel Fullerton Medical Group, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2269245
Angel Fullerton Medical Group · Fullerton, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Angel Fullerton Medical Group's NPI number?
The NPI number for Angel Fullerton Medical Group is 1689271389. It was assigned to this organization in the NPPES registry on October 6, 2020.
Where is Angel Fullerton Medical Group located?
Angel Fullerton Medical Group is located at 1125 W Orangethorpe Ave, Fullerton, CA 92833. The listed phone number is (714) 870-1888.
What is Angel Fullerton Medical Group's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Angel Fullerton Medical Group enrolled in Medicare?
Yes. Angel Fullerton Medical Group is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Angel Fullerton Medical Group?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Angel Fullerton Medical Group. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Angel Fullerton Medical Group hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2269245) is associated with this NPI, valid through September 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Angel Fullerton Medical Group was last updated on October 6, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Angel Fullerton Medical Group · NPI 1689271389
Primary Care organization in Fullerton, California. Organization record, active in the CMS NPPES registry since October 6, 2020.
## Identity
- **NPI:** 1689271389 (Entity type: Organization)
- **Enumerated:** October 6, 2020
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Gerardo Canchola, MEDICAL DIRECTOR
## Practice location
- **Address:** 1125 W ORANGETHORPE AVE, Fullerton, CA 92833-4735
- **Phone:** (714) 870-1888
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 6, 2020
- **Other identifiers:** Other 1720399843 (CA); Other 1639185879 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1689271389) · Data from the CMS NPPES public registry.