Organization
BEAVER MEDICAL GROUP LP
Active
Parent organization
MEDVANTX, INC.
Other names
Beaver Medical Group - Internal
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
2 W FERN AVE, SUITE 200, REDLANDS, CA 92373-5916
(909) 793-3311
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
A96734
CA
Other
Enumeration date
10/24/2013
Last updated
10/24/2013
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