Organization
DOCTORS MEDPLUS MEDICAL CENTER
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
877 OAK PARK BLVD, PISMO BEACH, CA 93449-3292
(805) 474-8450
Mailing address
5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G29852
CA
Other
Enumeration date
06/09/2009
Last updated
06/09/2009
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