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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