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

1504 A St
Antioch, CA 94509-2333

Phone

(925) 305-1855

Fax

(925) 755-8601

NPI assigned

Mar 6, 2008

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

Partner/Manager

Phone

(925) 305-1855

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336953600000",
    "number": "1902076987",
    "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": "1504 A ST",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092333",
            "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": "2008-03-06",
        "last_updated": "2012-05-14",
        "status": "A",
        "authorized_official_last_name": "BANTING",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER/MANAGER",
        "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": []
}

• Anita Luff, MS, CCC-SLP
• Eugene H Luk, OTR/L
• Samuel Lee Lum, PHARM.D, MBA
• Antonio Luo
• Robert Lurvey, MD
• Cayla Macayan
• Lindsay Macfarlane
• Fatima Macias
• Rhonda Lee Mackey
• Rikki Macklin

• Prosthetic/Orthotic Supplier in Antioch, CA
• Providers in Antioch, 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 14, 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.