Moulton Family Medicine
NPI #1164564712 in Lake Forest, California
Provider Information
- NPI Number
- 1164564712
- Entity Type
- Organization
- Organization Name
- Moulton Family Medicine
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MEDVANTX, INC.
- Primary Specialty
- Non-Pharmacy Dispensing Site
- Enumeration Date
- Feb 12, 2007
- Last Updated
- Oct 17, 2012
Practice Location
- Address
- 22611 LAKE FOREST DR
- Address 2
- C-4
- City
- Lake Forest
- State
- California
- ZIP Code
- 92630-1700
- Phone
- (949) 951-9399
Authorized Official
- Name
- KENNY HEINE
- Title
- DIRECTOR OF OPERATIONS
- Phone
- (858) 625-2990
Specialties & Taxonomy Codes
| Specialty |
|---|
| Non-Pharmacy Dispensing Site |
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