Organization
SEAL BEACH FAMILY MEDICAL GROUP, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
Seal Beach Family Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1198 PACIFIC COAST HWY, SEAL BEACH, CA 90740-6251
(562) 598-5474
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A36955
CA
Other
Enumeration date
10/15/2008
Last updated
10/23/2012
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