Organization
JOSEPH MEDICAL GROUP, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
JOSEPH MEDICAL GROUP - BUENA PARK
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (SR DIRECTOR OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
6261 STANTON AVE, BUENA PARK, CA 90621-2436
(714) 739-4325
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
G61950
CA
Other
Enumeration date
02/20/2012
Last updated
10/25/2012
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