Healthcare Provider Details

I. General information

NPI: 1871439711
Provider Name (Legal Business Name): MISSION VALLEY MEDICAL INFUSION CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 CAMINO DEL RIO N STE 200
SAN DIEGO CA
92108-1745
US

IV. Provider business mailing address

3530 CAMINO DEL RIO N STE 200
SAN DIEGO CA
92108-1745
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-9778
  • Fax: 619-374-1696
Mailing address:
  • Phone: 619-992-9778
  • Fax: 619-374-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT HENRY
Title or Position: OWNER
Credential: MD
Phone: 619-674-0111