NPIMap

Organization Active NPI

Clayton Valley Medical Group, Inc.

  • Non-Pharmacy Dispensing Site
  • Clayton, CA
National Provider Identifier
1720120819
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
G63252 Issued in CA
Legal business name
CLAYTON VALLEY MEDICAL GROUP, INC.
Practice address
1520 Kirker Pass Rd
Suite a
Clayton, CA 94517-1096
Phone
(925) 672-6744
NPI assigned
Feb 13, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
Dir. of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X G63252 CA Primary

Addresses

Primary practice location

1520 Kirker Pass Rd
Suite a
Clayton, CA 94517-1096

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

National Provider Directory

National Provider Directory
Part of
Tri - State Medical Group Inc

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1720120819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990",
            "fax_number": "858-625-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 KIRKER PASS RD",
            "address_2": "SUITE A",
            "city": "CLAYTON",
            "state": "CA",
            "postal_code": "945171096",
            "telephone_number": "925-672-6744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIR. OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G63252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.