Organization
SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE
Active
Parent organization
MEDVANTX, INC.
Other names
DANESH MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
31581 CANYON ESTATES DR, LAKE ELSINORE, CA 92532-0424
(951) 244-3500
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
A48943
CA
Other
Enumeration date
07/09/2012
Last updated
10/25/2012
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