# AVAOCADO MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932434438
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 1441 AVOCADO AVE, 702, NEWPORT BEACH, CA 92660-7721
- **Practice address phone:** (949) 720-9266
- **Mailing address:** 8941 ATLANTA AVE \# 522, HUNTINGTON BEACH, CA 92646-7121
- **Mailing address phone:** (714) 299-2666
- **Mailing address fax:** (949) 438-3868

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G50213 | CA | Yes |

## Other

- **Enumeration date:** 10/16/2009
- **Last updated:** 09/01/2020