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General NPI Number Information
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NPI Number | 1437377421
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Entity Type | Organization
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Legal Business Name | MARIN TREATMENT CENTER
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1466 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2021
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Country | US
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Telephone | 415-457-3755
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Fax | 415-457-9516
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Provider Business Mailing Address
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Address Line | 1466 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2021
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Country | US
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Telephone | 415-457-3755
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Fax | 415-457-9516
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | MR. JONATHAN FONG
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Credential | MBA
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Telephone | 415-457-3755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 110000417
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 21-70
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License Number State | CA
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