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Organization
PERFORMANCE HEALTH MEDICAL GROUP
Active
Organization
PERFORMANCE HEALTH MEDICAL GROUP
Active
Other names
Performance Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA GONZALEZ (NCPDP COORDINATOR)
(479) 636-9702
Entity
Organization
Contact information
Practice address
25431 CABOT ROAD SUITE 118, LAGUNA HILLS, CA 92653
(479) 636-9702
(877) 427-2307
Mailing address
PO BOX 3328, BENTONVILLE, AR 72712
(479) 636-9702
(877) 427-2307
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G45164
CA
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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