# JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CA

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

## Provider details

- **NPI number:** 1760860894
- **Legal business name:** MEDVANTX,INC
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 887 E 2ND ST, POMONA, CA 91766-2009
- **Practice address phone:** (909) 620-7769
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 93810 | CA | Yes |

## Other

- **Enumeration date:** 05/08/2015
- **Last updated:** 05/08/2015