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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