SEAL BEACH FAMILY MEDICAL GROUP, INC. (NPI# 1538311063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538311063 |
| Entity Type | Organization |
| Organization Name | SEAL BEACH FAMILY MEDICAL GROUP, INC. |
| Other Organization Name | SEAL BEACH FAMILY MEDICAL GROUP |
| Practice Address |
1198 Pacific Coast Hwy Seal Beach CA 90740-6251 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 5625985474 |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2012-10-23 |
| Authorized Official Name | KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | A36955 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| Seal Beach Family Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215041801 | Seal Beach Family Medical Group, Inc. | Family Medicine | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2006-08-19 |
| Street Address |
1198 PACIFIC COAST HWY |
| City | SEAL BEACH |
| State | CA |
| Zip Code | 90740-6251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811936545 | Kendell A Simm | Physician Assistant | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2006-06-06 |
| 1184198616 | Riley Newcomb | Physician Assistant | 1198 Pacific Coast Hwy, Seal Beach, CA 90740-6251 | 2019-01-17 |
| 1760759906 | Cindy Zia | Family Medicine | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2011-11-16 |
| 1437472016 | Laura L Mc Ewan | Nurse Practitioner | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2010-03-10 |
| 1760647853 | Lauren N Swanson | Physician Assistant | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2008-07-28 |
| 1891917944 | Seal Beach Urgent Care Medical Corporation | Clinic/Center | 1198 Pacific Coast Hwy, Suite J, Seal Beach, CA 90740-6251 | 2007-05-02 |
| 1124166772 | Ourania Zoie Papantoniadis | Physician Assistant | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2007-02-02 |
| 1497893051 | Stephen E Teipe | Physician Assistant | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2007-02-02 |
| 1972658375 | Christine Carreon | Nurse Practitioner | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2007-01-24 |
| 1982710190 | Alan M Tenazas | Physician Assistant | 1198 Pacific Coast Hwy, Suite I, Seal Beach, CA 90740-6251 | 2006-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013564608 | Betty Lou Halloran | Technician | 1320 Kenwood Rd 158g, Seal Beach, CA 90740 | 2019-08-20 |
| 1235794975 | Elizabeth Irene Williams | Behavior Technician | 30002 Dow Ave #122, Tustin, CA 90740 | 2019-05-08 |
| 1679994834 | Alexis Worth | Nurse Practitioner | 1305 Catalina Ave., Seal Beach, CA 90740 | 2013-12-13 |
| 1386074128 | Santa Ana Hospice Inc | Hospice Care, Community Based | 610 Pacific Coast Hwy Ste 211, Seal Beach, CA 90740 | 2013-11-14 |
| 1902242019 | Bernard Georges Gantes | Dentist | 2999 Westminster, Suite 108, Seal Beach, CA 90740 | 2013-05-15 |
| 1144592064 | Brooke Ashley Pancer | Dentist | 2999 Westminster Blvd Seal Beach Dental Implants, Seal Beach, CA 90740 | 2012-02-08 |
| 1003187808 | Justin Cheongsiatmoy | Psychiatry & Neurology | 1301 Kenwood Road, Suite 159b, Seal Beach, CA 90740 | 2012-01-25 |
| 1386912830 | A Peace of Mind Home Care LLC | In Home Supportive Care | 1050 Electric Ave, Suite 308-1, Seal Beach, CA 90740 | 2011-12-12 |
| 1770888430 | Kathleen Cleary Adamovic | Marriage & Family Therapist | 500 Pacific Coast Highway, Suite 214, Seal Beach, CA 90740 | 2011-01-11 |
| 1710218177 | Misty Oppenheim-leaf | Behavioral Analyst | 200 Marina Drive, Suite C, Seal Beach, CA 90740 | 2010-01-26 |
| Find all providers in zip 90740 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| Find all providers with the same taxonomy | ||||
| City | SEAL BEACH |
| Zip Code | 90740 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.