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Organization
HIGH DESERT PRIMARY CARE
Active
Organization
HIGH DESERT PRIMARY CARE
Active
Parent organization
MEDVANTX, INC.
Other names
High Desert Primary Care - Victorville
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
12550 HESPERIA RD, VICTORVILLE, CA 92395-5873
(760) 241-6666
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A53356
CA
Other
Enumeration date
09/11/2007
Last updated
10/22/2012
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