# JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** Molina San Bernardino
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1720465206
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 190 E HIGHLAND AVE, SAN BERNARDINO, CA 92404-3658
- **Practice address phone:** (909) 882-4788
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A110824 | CA | Yes |

## Other

- **Enumeration date:** 05/04/2015
- **Last updated:** 05/04/2015