Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA
Active
Parent organization
MEDVANTX, INC.
Other names
Molina Adelanto
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
11965 CACTUS RD, ADELANTO, CA 92301-4906
(760) 561-6081
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
10574
CA
Other
Enumeration date
05/04/2015
Last updated
05/04/2015
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