Organization
PERFORMANCE HEALTH MEDICAL GROUP
Active
Parent organization
MEDVANTX, INC.
Other names
Performance Health Medical Group
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
25431 CABOT RD, SUITE 118, LAGUNA HILLS, CA 92653-5518
(949) 287-4559
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
G45164
CA
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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