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General NPI Number Information
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NPI Number | 1639965767
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Entity Type | Organization
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Legal Business Name | MKG MEDICAL NETWORK ASSISTANCE LLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | ISLA MARGARITA 2890 JARDINES DE LA CRUZ
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City | GUADALAJARA
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State | JALISCO
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Zip | 44650
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Country | MX
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Telephone | 619-936-4564
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Fax |
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Provider Business Mailing Address
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Address Line | 333 H ST STE 5000
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City | CHULA VISTA
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State | CA
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Zip | 91910-5561
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Country | US
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Telephone | 619-988-6512
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JORGE A CALDERON
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Credential |
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Telephone | 619-936-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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