Healthcare Provider Details

I. General information

NPI: 1639965767
Provider Name (Legal Business Name): MKG MEDICAL NETWORK ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISLA MARGARITA 2890 JARDINES DE LA CRUZ
GUADALAJARA JALISCO
44650
MX

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 619-936-4564
  • Fax:
Mailing address:
  • Phone: 619-988-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JORGE A CALDERON
Title or Position: MANAGER
Credential:
Phone: 619-936-4564