# JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** Molina 55th Street
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1578965315
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 7215 55TH ST, SACRAMENTO, CA 95823-2601
- **Practice address phone:** (916) 399-1100
- **Mailing address:** 9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G35264 | CA | Yes |

## Other

- **Enumeration date:** 09/24/2014
- **Last updated:** 12/29/2015