Healthcare Provider Details

I. General information

NPI: 1477892099
Provider Name (Legal Business Name): MARIN MAGNETIC RESONANCE IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S ELISEO DR SUITE 101
GREENBRAE CA
94904-2009
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-9033
  • Fax: 415-883-0877
Mailing address:
  • Phone: 415-884-3404
  • Fax: 415-883-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P. BELICK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-884-3096