# IRVINE PROFESSIONAL MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** IRVINE PROFESSIONAL MEDICAL GROUP, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568702835
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OPS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 3500 BARRANCA PKWY, SUITE 330, IRVINE, CA 92606-8226
- **Practice address phone:** (949) 552-8217
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A107209 | CA | Yes |

## Other

- **Enumeration date:** 02/25/2013
- **Last updated:** 02/25/2013