ANGEL FULLERTON MEDICAL GROUP
NPI 1689271389
Clinic/Center - Primary Care in Fullerton, CA

Active since October 06, 2020CLIA 05D2269245 · Waiver
1125 W ORANGETHORPE AVE, FULLERTON, CA 92833(714) 870-1888 Get Directions Write a Review

NPPES record last updated: October 6, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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, 2026 and lists Gerardo Canchola, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1689271389
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameANGEL FULLERTON MEDICAL GROUP
Location Address1125 W ORANGETHORPE AVEFullerton, CA 92833-4735
Mailing Address1125 W Orangethorpe AveFullerton, CA 92833-4735 · (714) 870-1888
Organization SubpartNo
Authorized OfficialGerardo CancholaMedical Director · (714) 662-7710
Enumeration DateOctober 6, 2020
NPPES CertifiedOctober 6, 2020
NPI 1689271389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1125 W ORANGETHORPE AVE, Fullerton, CA 92833

Other Identifiers 2

Other1720399843CA · General Practice
Other1639185879CA · General Practice

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, CA
Active · expires Sep 21, 2026
CLIA Number05D2269245
Laboratory TypePhysician Office
Certificate Effective DateSeptember 22, 2024
Certificate Expiration DateSeptember 21, 2026
Laboratory DirectorGerardo Canchola
Laboratory Phone(714) 870-1888
Laboratory LocationAngel Fullerton Medical Group1125 W Orangethorpe Ave, Fullerton, CA 92833
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Preferred Provider Organization
1125 W ORANGETHORPE AVE
FULLERTON, CA 92833

Frequently 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.

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, 2026. 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 5 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.