MEDICARE: AMG PARTNERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1578836383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMG PARTNERS LLC

Provider Business Mailing Address
First Line	:	2618 SAN MIGUEL DR
Second Line	:	STE 110
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	951-445-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 SAN MIGUEL DR
Second Line	:	STE 110
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	909-786-4436
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MR. MARK GAETA
Credential	:
Telephone Number	:	917-696-4971

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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