Healthcare Provider Details

I. General information

NPI: 1689654964
Provider Name (Legal Business Name): SUTTER MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ROWLAND WAY
NOVATO CA
94945
US

IV. Provider business mailing address

PO BOX 1108
NOVATO CA
94948-1108
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-1300
  • Fax: 415-209-1321
Mailing address:
  • Phone: 415-209-1300
  • Fax: 415-209-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID BRADLEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-925-7100