# PALO ALTO MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** Sutter Sant Cruz Main 4th Floor
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114182649
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 2025 SOQUEL AVE, 4TH FLOOR, SANTA CRUZ, CA 95062-1323
- **Practice address phone:** (831) 458-5610
- **Mailing address:** 5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
- **Mailing address phone:** (858) 625-2990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G84273 | CA | Yes |

## Other

- **Enumeration date:** 07/24/2008
- **Last updated:** 07/25/2008