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Organization
HERITAGE VICTOR VALLEY MEDICAL GROUP
Active
Organization
HERITAGE VICTOR VALLEY MEDICAL GROUP
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
12408 HESPERIA RD, #2, VICTORVILLE, CA 92395-7718
(760) 245-4747
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
54968
CA
Other
Enumeration date
10/23/2009
Last updated
11/30/2015
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