Organization
IRVINE PROFESSIONAL MEDICAL GROUP, INC
Active
Parent organization
MEDVANTX, INC.
Other names
IRVINE PROFESSIONAL MEDICAL GROUP, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
3500 BARRANCA PKWY, SUITE 330, IRVINE, CA 92606-8226
(949) 552-8217
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
A107209
CA
Other
Enumeration date
02/25/2013
Last updated
02/25/2013
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