# JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX INC
- **Other names:** Molina North Long Beach
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083017834
- **Legal business name:** MEDVANTX INC
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 540 E ARTESIA BLVD, LONG BEACH, CA 90805-1476
- **Practice address phone:** (562) 423-3383
- **Mailing address:** 9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 20A10903 | CA | Yes |

## Other

- **Enumeration date:** 10/07/2014
- **Last updated:** 12/03/2015