Healthcare Provider Details

I. General information

NPI: 1992466288
Provider Name (Legal Business Name): MARIN MEDICAL LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 HARRISON AVE
EUREKA CA
95501-3218
US

IV. Provider business mailing address

1615 HILL RD STE B
NOVATO CA
94947-4338
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax: 707-269-3889
Mailing address:
  • Phone: 415-209-6983
  • Fax: 415-898-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEDAR CHE PRASAD
Title or Position: PATHOLOGIST, PARTNER
Credential: MD
Phone: 415-925-7174