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Organization
BRISTOL PARK MEDICAL GROUP
Active
Organization
BRISTOL PARK MEDICAL GROUP
Active
Parent organization
MEDVANTX, INC.
Other names
BPMG - Costa Mesa
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
722 BAKER ST, COSTA MESA, CA 92626-4320
(714) 557-6300
Mailing address
5810 NANCY RIDGE DR, SAN DIEGO, CA 92121-2834
(858) 625-2990
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A87971
CA
Other
Enumeration date
02/12/2007
Last updated
05/29/2009
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