Healthcare Provider Details

I. General information

NPI: 1538049598
Provider Name (Legal Business Name): COLIN HAMBLIN, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 SIR FRANCES DRAKE BLVD SUITE 206A
GREENBRAE CA
94904
US

IV. Provider business mailing address

PO BOX 240
POINT REYES STATION CA
94956
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-1082
  • Fax: 415-663-9474
Mailing address:
  • Phone: 415-663-1082
  • Fax: 415-663-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BASIL COLIN HAMBLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 415-663-1082