Provider Demographics
NPI:1578836383
Name:AMG PARTNERS LLC
Entity Type:Organization
Organization Name:AMG PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-696-4971
Mailing Address - Street 1:2618 SAN MIGUEL DR
Mailing Address - Street 2:STE 110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5437
Mailing Address - Country:US
Mailing Address - Phone:951-445-3883
Mailing Address - Fax:
Practice Address - Street 1:2618 SAN MIGUEL DR
Practice Address - Street 2:STE 110
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5437
Practice Address - Country:US
Practice Address - Phone:909-786-4436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory