Organization
MEMORIALCARE HEALTH SYSTEM
Active
Organization
MEMORIALCARE HEALTH SYSTEM
Active
Other names
Cancer Risk and Prevention Program
Organization subpart
No
Provider details
NPI number
Authorized official
JENNA TIDWELL MS (GENETIC COUNSELOR)
(949) 452-8854
Entity
Organization
Contact information
Practice address
24302 PASEO DE VALENCIA, LAGUNA HILLS, CA 92653-3115
(949) 452-8854
Mailing address
24302 PASEO DE VALENCIA, LAGUNA HILLS, CA 92653-3115
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
GC000665
CA
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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