Organization
BEAVER MEDICAL GROUP LP
Active
Parent organization
MEDVANTX, INC.
Other names
Beaver Medical Group - Highland Extended Care
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
7000 BOULDER AVE, HIGHLAND, CA 92346-3348
(909) 862-1191
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
A69210
CA
Other
Enumeration date
04/29/2008
Last updated
06/09/2016
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