Organization
GERIATRIC SPECIALTIES OF ARIZONA PC
Active
Parent organization
MEDVANTX, INC.
Other names
Geriatric Specialties of Arizona
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
6838 N 23RD AVE, PHOENIX, AZ 85015-1056
(602) 864-8800
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
19651
AZ
Other
Enumeration date
04/17/2014
Last updated
11/10/2014
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