Provider Demographics
NPI:1508602079
Name:M&G TRANSPORT LLC
Entity type:Organization
Organization Name:M&G TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERRREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-613-6181
Mailing Address - Street 1:PO BOX 59773
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-0773
Mailing Address - Country:US
Mailing Address - Phone:408-613-6181
Mailing Address - Fax:
Practice Address - Street 1:446 CLOGSTON CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-2322
Practice Address - Country:US
Practice Address - Phone:408-613-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)