Organization
PERFORMANCE HEALTH MEDICAL GROUP
Active
Other names
Performance Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA GONZALEZ (NCPDP COORDINATOR)
(479) 636-9702
Entity
Organization
Contact information
Practice address
25431 CABOT ROAD SUITE 118, LAGUNA HILLS, CA 92653
(479) 636-9702
(877) 427-2307
Mailing address
PO BOX 3328, BENTONVILLE, AR 72712
(479) 636-9702
(877) 427-2307
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G45164
CA
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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