Provider Demographics
NPI:1154748903
Name:SIXTEEN:FIVE GROUP INC
Entity type:Organization
Organization Name:SIXTEEN:FIVE GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:MAGSAYSAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-599-2737
Mailing Address - Street 1:7702 ALDEA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2107
Mailing Address - Country:US
Mailing Address - Phone:818-599-2737
Mailing Address - Fax:
Practice Address - Street 1:7702 ALDEA AVE
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-2107
Practice Address - Country:US
Practice Address - Phone:818-599-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle