Provider Demographics
NPI:1912653288
Name:MEMORIALCARE MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:MEMORIALCARE MEDICAL FOUNDATION
Other - Org Name:MEMORIALCARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:18111 BROOKHURST ST., STE 6100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-378-7330
Mailing Address - Fax:714-377-0003
Practice Address - Street 1:18111 BROOKHURST ST., STE 6100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-378-7330
Practice Address - Fax:714-377-0003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site