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Organization
GENESIS MEDICAL CLINIC
Active
Organization
GENESIS MEDICAL CLINIC
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
6189 LA PALMA AVE, BUENA PARK, CA 90620-2858
(714) 522-2891
Mailing address
5626 OBERLIN DR, 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
11986
CA
Other
Enumeration date
11/16/2009
Last updated
12/03/2014
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