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1437377421 NPI number — MARIN TREATMENT CENTER

NPI Number: 1437377421
Health Care Provider/Practitioner: MARIN TREATMENT CENTER

Information about “1437377421” NPI (MARIN TREATMENT CENTER) exists in 1437377421 in HTML format HTML  |  1437377421 in plain Text format TXT  |  1437377421 in PDF (Portable Document Format) PDF  |  1437377421 in an XML format XML  formats.

NPI Number : 1437377421 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437377421",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MARIN TREATMENT CENTER",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1466 LINCOLN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN RAFAEL",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94901-2021",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "415-457-3755",
    "MailingAddressFaxNumber": "415-457-9516",
    "FirstLinePracticeLocationAddress": "1466 LINCOLN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN RAFAEL",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94901-2021",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-457-3755",
    "PracticeLocationAddressFaxNumber": "415-457-9516",
    "EnumerationDate": "04/23/2007",
    "LastUpdateDate": "03/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FONG",
    "AuthorizedOfficialFirstName": "JONATHAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ASSOCIATE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "415-457-3755",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QP2300X",
          "TaxonomyName": "Primary Care Clinic/Center",
          "LicenseNumber": "110000417",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM2800X",
          "TaxonomyName": "Methadone Clinic",
          "LicenseNumber": "21-70",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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