Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA
Active
Parent organization
MEDVANTX, INC.
Other names
Molina 55th Street
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
7215 55TH ST, SACRAMENTO, CA 95823-2601
(916) 399-1100
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G35264
CA
Other
Enumeration date
09/24/2014
Last updated
12/29/2015
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