Organization
NORTH COUNTY INTERNISTS MEDICAL CORPORATION
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
SCOTT PETERSON (CFO)
(858) 625-2990
Entity
Organization
Contact information
Practice address
15721 POMERADO RD, POWAY, CA 92064-2021
(858) 485-7454
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G24300
CA
Other
Enumeration date
02/12/2007
Last updated
01/13/2017
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