# BREA FAMILY CARE A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX INC
- **Other names:** BREA FAMILY CARE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457601890
- **Legal business name:** MEDVANTX INC
- **Authorized official:** KENNY HEINE (VP OPS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 400 W CENTRAL AVE, 106, BREA, CA 92821
- **Practice address phone:** (714) 990-1882
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A60060 | CA | Yes |

## Other

- **Enumeration date:** 09/13/2012
- **Last updated:** 10/23/2012