Provider Demographics
NPI:1760135677
Name:MEMORIALCARE MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:MEMORIALCARE MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCMF-SENIOR MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:657-241-3499
Mailing Address - Street 1:1441 AVOCADO AVENUE, SUITE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-272-2095
Mailing Address - Fax:949-272-2096
Practice Address - Street 1:1441 AVOCADO AVENUE, SUITE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-272-2095
Practice Address - Fax:949-272-2096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site