Healthcare Provider Details

I. General information

NPI: 1740780923
Provider Name (Legal Business Name): MARIN CITY COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 DRAKE AVE
SAUSALITO CA
94965-1105
US

IV. Provider business mailing address

441 DRAKE AVE
SAUSALITO CA
94965-1105
US

V. Phone/Fax

Practice location:
  • Phone: 415-339-2837
  • Fax: 415-332-0337
Mailing address:
  • Phone: 415-339-2837
  • Fax: 415-332-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA M CADET
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 415-339-2837