Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA
Active
Parent organization
MEDVANTX INC
Other names
Molina North Long Beach
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX INC
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
540 E ARTESIA BLVD, LONG BEACH, CA 90805-1476
(562) 423-3383
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
20A10903
CA
Other
Enumeration date
10/07/2014
Last updated
12/03/2015
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