Organization
INNOVAGE HEALTH PARTNERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA D WALTON (CHIEF LEGAL OFFICER)
(720) 974-2459
Entity
Organization
Contact information
Practice address
410 E PARKCENTER CIR N, SAN BERNARDINO, CA 92408-2869
(909) 890-2800
(909) 890-9615
Mailing address
410 E PARKCENTER CIR N, SAN BERNARDINO, CA 92408-2869
(909) 890-2800
(909) 890-9615
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
53735
CA
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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