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General NPI Number Information
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NPI Number | 1346532314
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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 | 05/10/2011
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 347 ANDRIEUX ST
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City | SONOMA
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State | CA
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Zip | 95476-6811
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Country | US
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Telephone | 707-935-5185
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Fax | 707-935-5437
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Provider Business Mailing Address
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Address Line | 1615 HILL RD STE B
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City | NOVATO
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State | CA
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Zip | 94947-4338
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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 | PATHOLOGIST
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Name | DR. KEDAR CHE PRASAD
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Credential | MD
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Telephone | 415-209-6017
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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 | CLF 1363
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License Number State | CA
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