Organization
FAMILY PRACTICE OF WEST VOLUSIA INC
Active
Organization
FAMILY PRACTICE OF WEST VOLUSIA INC
Active
Parent organization
MEDVANTX
Other names
FAMILY PRACTICE OF WEST VOLUSIA- DELAND
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
862 PEACHWOOD DR, DELAND, FL 32720-0834
(386) 960-2009
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
OS6029
FL
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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