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MOULTON FAMILY MEDICINE
NPI 1164564712
Non-Pharmacy Dispensing Site in Lake Forest, CA

Active since February 12, 2007
22611 LAKE FOREST DR, C-4, LAKE FOREST, CA 92630(949) 951-9399 Get Directions Write a Review

NPPES record last updated: October 17, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Moulton Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOULTON FAMILY MEDICINE (NPI 1164564712) is a healthcare organization registered as a non-pharmacy dispensing site in Lake Forest, California and active in the NPI registry since February 2007. The organization lists Kenny Heine, Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1164564712
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameMOULTON FAMILY MEDICINE
Location Address22611 LAKE FOREST DR, C-4Lake Forest, CA 92630-1700
Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705
Phone(949) 951-9399
Organization SubpartYesParent: Medvantx, Inc.
Authorized OfficialKenny HeineDirector Of Operations · (858) 625-2990
Enumeration DateFebruary 12, 2007
Last NPPES UpdateOctober 17, 2012
✔ NPI 1164564712 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in CA · A47792
Definition
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.)
22611 LAKE FOREST DR, Lake Forest, CA 92630
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ADEL BOUTROS MD
Family Medicine
22611 LAKE FOREST DR
LAKE FOREST, CA 92630
Orange County (949) 951-9399
PARK DENTAL GROUP INC
Clinic/Center (Dental)
22611 LAKE FOREST DR
LAKE FOREST, CA 92630
Orange County (909) 543-5075
FARHAD KIANI DDS A PROFESSIONAL CORPORATION
Dentist
22611 LAKE FOREST DR, SUITE C-5
LAKE FOREST, CA 92630
Orange County (949) 777-6688

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moulton Family Medicine's NPI number?

The NPI number for Moulton Family Medicine is 1164564712. It was assigned to this organization in the NPPES registry on February 12, 2007.

Where is Moulton Family Medicine located?

Moulton Family Medicine is located at 22611 Lake Forest Dr C-4, Lake Forest, CA 92630. The listed phone number is (949) 951-9399.

What is Moulton Family Medicine's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

When was this NPI record last updated?

The NPPES record for Moulton Family Medicine was last updated on October 17, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.