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Organization

HIGH DESERT PRIMARY CARE MEDICAL GROUP

Active
Parent organization
MEDVANTX, INC.
Other names
High Desert Primary Care - Apple Valley
Organization subpart
Yes

Provider details

NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (SR. DIRECTOR OPERATIONS)
(858) 625-2990
Entity
Organization

Contact information

Practice address
19333 BEAR VALLEY RD, 101, APPLE VALLEY, CA 92308-5148
(760) 240-3784
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
A49522
CA

Other

Enumeration date
05/24/2010
Last updated
10/23/2012
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