MEDICARE: TARA SHORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1710288485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA SHORT

Provider Business Mailing Address
First Line	:	655 E HUNTINGTON DR
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-3636
Country	:	US
Telephone Number	:	800-426-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 FROST ST STE 430
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2795
Country	:	US
Telephone Number	:	800-426-6467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	06/17/2015

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Directions to “ TARA SHORT ” Practice Location

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