# FCS - MONTEBELLO

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1972778025
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** MAURICIO EDUARDO BUENO MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (323) 791-0557

## Contact information

- **Practice address:** 815 WASHINGTON BLVD, MONTEBELLO, CA 90640-6123
- **Practice address phone:** (323) 728-3955
- **Mailing address:** 5626 OBERLIN DR STE 110, SAN DIEGO, CA 92121-1705
- **Mailing address phone:** (323) 317-9200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G52360 | CA | Yes |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 03/31/2026