Organization
CLINICA FAMILIAR COSTA CENTRAL
Active
Parent organization
MEDVANTX, INC.
Other names
Clinica Familiar Costa Central - Ariel Martinez, MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1185 FREEDOM BLVD STE 1, WATSONVILLE, CA 95076-2776
(831) 786-9250
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
A65977
CA
Other
Enumeration date
02/12/2007
Last updated
10/17/2012
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