M&G Custom Shoes and Orthotics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CPED0350 Issued in CA

Legal business name

M&G CUSTOM SHOES AND ORTHOTICS LLC

Practice address

2950 Buskirk Ave
Suite 300
Walnut Creek, CA 94597-7779

Phone

(925) 305-1855

Fax

(925) 755-8601

NPI assigned

May 4, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Gregory R Banting, C.PED.

Title

Owner/Partner

Phone

(925) 305-1855

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1609135029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 A ST",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092333",
            "telephone_number": "925-305-1855",
            "fax_number": "925-755-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 BUSKIRK AVE",
            "address_2": "SUITE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945977779",
            "telephone_number": "925-305-1855",
            "fax_number": "925-755-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M&G CUSTOM SHOES AND ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "BANTING",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "925-305-1855",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.PED."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CA",
            "license": "CPED0350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Lynch
• Emily Lynch
• Matthew Isaac Lyons
• Meg Lyskawa
• M Plus R LLC
• Daniel Ma
• Danning Ma
• Edward Christopher Ma, PHARM D
• Ming-Tyh Maa, M.D.
• Pamela Alaura Macapagal, RN

• Prosthetic/Orthotic Supplier in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.