Healthcare Provider Details

I. General information

NPI: 1457496655
Provider Name (Legal Business Name): TIDES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY 200
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

655 REDWOOD HWY SUITE 200
MILL VALLEY CA
94941-3034
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-6623
  • Fax: 415-383-6671
Mailing address:
  • Phone: 415-383-6623
  • Fax: 415-383-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. MILTON ESTES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-383-6623