Healthcare Provider Details

I. General information

NPI: 1285468819
Provider Name (Legal Business Name): MKG MEDICAL NETWORK ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 H ST STE 5000
CHULA VISTA CA
91910-5561
US

IV. Provider business mailing address

333 H ST STE 5000
CHULA VISTA CA
91910-5561
US

V. Phone/Fax

Practice location:
  • Phone: 619-988-6512
  • Fax:
Mailing address:
  • Phone: 619-988-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416S0300X
TaxonomyWater Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SALVADOR GONZALEZ
Title or Position: CEO
Credential:
Phone: 956-482-7011