# HIGH DESERT PRIMARY CARE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** High Desert Primary Care - Apple Valley
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1942529482
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (SR. DIRECTOR OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 19333 BEAR VALLEY RD, 101, APPLE VALLEY, CA 92308-5148
- **Practice address phone:** (760) 240-3784
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A49522 | CA | Yes |

## Other

- **Enumeration date:** 05/24/2010
- **Last updated:** 10/23/2012