M&g Custom Shoes and Orthotics LLC
NPI #1902076987 in Antioch, California
Provider Information
- NPI Number
- 1902076987
- Entity Type
- Organization
- Organization Name
- M&g Custom Shoes and Orthotics LLC
- Primary Specialty
- Prosthetic/Orthotic Supplier
- Enumeration Date
- Mar 6, 2008
- Last Updated
- May 14, 2012
Practice Location
- Address
- 1504 A ST
- City
- Antioch
- State
- California
- ZIP Code
- 94509-2333
- Phone
- (925) 305-1855
Authorized Official
- Name
- MR. GREGORY R BANTING, C.PED.
- Title
- PARTNER/MANAGER
- Phone
- (925) 305-1855
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetic/Orthotic Supplier |
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