Organization
MEMORIALCARE MEDICAL GROUP, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
MemorialCare Medical Group - Santa Ana
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
1212 W 17TH ST, SANTA ANA, CA 92706-3418
(714) 954-0432
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
(858) 625-2990
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A44130
CA
Other
Enumeration date
02/12/2007
Last updated
04/03/2013
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