# PERFORMANCE HEALTH MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Performance Health Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023511045
- **Authorized official:** MRS. AMANDA GONZALEZ (NCPDP COORDINATOR)
- **Authorized official phone:** (479) 636-9702

## Contact information

- **Practice address:** 25431 CABOT ROAD SUITE 118, LAGUNA HILLS, CA 92653
- **Practice address phone:** (479) 636-9702
- **Practice address fax:** (877) 427-2307
- **Mailing address:** PO BOX 3328, BENTONVILLE, AR 72712
- **Mailing address phone:** (479) 636-9702
- **Mailing address fax:** (877) 427-2307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G45164 | CA | Yes |

## Other

- **Enumeration date:** 03/15/2018
- **Last updated:** 03/15/2018