Healthcare Provider Details

I. General information

NPI: 1255178133
Provider Name (Legal Business Name): MARIN COUNTY PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 KERNER BLVD
SAN RAFAEL CA
94901-4840
US

IV. Provider business mailing address

3240 KERNER BLVD
SAN RAFAEL CA
94901-4840
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-4163
  • Fax:
Mailing address:
  • Phone: 415-473-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE JEAN BARRETT
Title or Position: ADMINISTRATIVE SERVICES ASSOCIATE
Credential:
Phone: 415-473-6847