Healthcare Provider Details

I. General information

NPI: 1568525699
Provider Name (Legal Business Name): COUNTY OF MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

20 N SAN PEDRO RD
SAN RAFAEL CA
94903-4188
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-7818
  • Fax: 415-473-4283
Mailing address:
  • Phone: 415-473-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCA

VIII. Authorized Official

Name: ROSANNA LALLANA
Title or Position: COMPLIANCE PRIVACY SECURITY OFCR
Credential:
Phone: 415-473-2531