Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA
Active
Parent organization
MEDVANTX, INC.
Other names
Molina East 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
1627 E ANAHEIM ST, LONG BEACH, CA 90813-3809
(877) 665-4623
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G79542
CA
Other
Enumeration date
10/13/2014
Last updated
04/23/2015
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