Healthcare Provider Details

I. General information

NPI: 1871246777
Provider Name (Legal Business Name): MEMORIALCARE MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S. MAIN ST, SUITE 100
ORANGE CA
92868
US

IV. Provider business mailing address

230 S. MAIN ST, SUITE 100
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-0101
  • Fax: 714-541-0450
Mailing address:
  • Phone: 714-541-0101
  • Fax: 714-541-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: TANYA DANSKY
Title or Position: MCMF - SENIOR MEDICAL DIRECTOR
Credential:
Phone: 657-241-3499