Healthcare Provider Details

I. General information

NPI: 1629335021
Provider Name (Legal Business Name): MARIN IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BRIDGE ST SUITE 2A
SAN ANSELMO CA
94960-2040
US

IV. Provider business mailing address

6 BRIDGE ST SUITE 2A
SAN ANSELMO CA
94960-2040
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-1750
  • Fax: 866-580-9020
Mailing address:
  • Phone: 415-454-1750
  • Fax: 866-580-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberDC 26700
License Number StateCA

VIII. Authorized Official

Name: DR. RACHAEL CORSANO
Title or Position: OWNER / OPERATOR
Credential: D.C.
Phone: 415-454-1750