Organization
M&G CUSTOM SHOES AND ORTHOTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY R BANTING C.PED. (PARTNER/MANAGER)
(925) 305-1855
Entity
Organization
Contact information
Practice address
1504 A ST, ANTIOCH, CA 94509-2333
(925) 305-1855
(925) 755-8601
Mailing address
1504 A ST, ANTIOCH, CA 94509-2333
(925) 305-1855
(925) 755-8601
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPED0350
CA
Other
Enumeration date
03/06/2008
Last updated
05/14/2012
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