Genesis Medical Clinic

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

11986 Issued in CA

Legal business name

GENESIS MEDICAL CLINIC

Practice address

6189 La Palma Ave
Buena Park, CA 90620-2858

Phone

(714) 522-2891

NPI assigned

Nov 16, 2009

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

VP Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Tri - State Medical Group Inc

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Terry KB Fowler, D.O.

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1770584989
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1932436714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6189 LA PALMA AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906202858",
            "telephone_number": "714-522-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2009-11-16",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "11986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Elena Garcia
• Jocelyn Garduno
• Garfield Beach CVS LLC
• Garfield Beach CVS LLC
• Shana Gaudreau
• Genoa Healthcare LLC
• Gentle Mobile Phlebotomist LLC
• Genus Medical Group
• GFK Services, Inc
• Razia Ghafoori, AMFT

• Non-Pharmacy Dispensing Site in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.