Organization
PRIMA MEDICAL GROUP, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
Prima Medical Group - Drakes Landing
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1260 S ELISEO DR, GREENBRAE, CA 94904-2009
(415) 924-1214
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
A72388
CA
Other
Enumeration date
03/31/2008
Last updated
07/17/2015
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