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General NPI Number Information
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NPI Number | 1144326471
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Entity Type | Organization
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Legal Business Name | MARIN MEDICAL LABORATORIES
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 1615 HILL ROAD SUITE B
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City | NOVATO
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State | CA
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Zip | 94947
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Country | US
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Telephone | 415-898-7649
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Fax | 415-898-0870
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Provider Business Mailing Address
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Address Line | 1615 HILL ROAD SUITE B
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City | NOVATO
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State | CA
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Zip | 94947
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Country | US
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Telephone | 415-898-7649
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Fax | 415-898-0870
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PAUL WILLIAM WASSERSTEIN
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Credential | MD
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Telephone | 415-925-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | CLF789
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License Number State | CA
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