MEDICARE: MS. JEANNE HOMER MS, CGC

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	:	1255320776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE HOMER MS, CGC

Provider Business Mailing Address
First Line	:	8 CORAL TREE LN
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2204
Country	:	US
Telephone Number	:	949-786-0437
Fax Number	:	949-786-2220

Provider Business Practice Location Address
First Line	:	ONE HOAG DR, BLDG 41
Second Line	:	HOAG CANCER CENTER
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-6100
Country	:	US
Telephone Number	:	949-764-5764
Fax Number	:	949-764-8102

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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