Healthcare Provider Details

I. General information

NPI: 1285823617
Provider Name (Legal Business Name): COMMUNITY ACTION MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 NORTHGATE DR STE 201
SAN RAFAEL CA
94903-3696
US

IV. Provider business mailing address

555 NORTHGATE DR STE 201
SAN RAFAEL CA
94903-3696
US

V. Phone/Fax

Practice location:
  • Phone: 415-526-7500
  • Fax: 415-457-9677
Mailing address:
  • Phone: 415-526-7500
  • Fax: 415-457-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: CHANDRA ALEXANDRE
Title or Position: CEO
Credential: PHD
Phone: 415-526-7511