Healthcare Provider Details

I. General information

NPI: 1649305459
Provider Name (Legal Business Name): MARIN GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CIVIC CENTER DR 160
SAN RAFAEL CA
94903-4171
US

IV. Provider business mailing address

639 LARKSPUR PLAZA DR
LARKSPUR CA
94939-1451
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-4790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number91018234
License Number StateCA

VIII. Authorized Official

Name: MS. DAVID BRADLEY
Title or Position: CEO
Credential:
Phone: 415-925-7100