Organization
DENNIS RIFF MD INC STEVEN DUCKOR PROF CORP EL AL
Active
Parent organization
MEDVANTX, INC.
Other names
ASSOCIATED GASTROENTEROLOGY MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
1211 W LA PALMA AVE, 306, ANAHEIM, CA 92801-2815
(714) 778-1300
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
G22807
CA
Other
Enumeration date
10/17/2012
Last updated
10/23/2012
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