Healthcare Provider Details

I. General information

NPI: 1124021738
Provider Name (Legal Business Name): MARIN COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

300 PROFESSIONAL CENTER DR STE 311
NOVATO CA
94947-4334
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax: 415-461-4229
Mailing address:
  • Phone: 415-448-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number1100366
License Number StateCA

VIII. Authorized Official

Name: BRENDA SHIPP
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-475-4572