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General NPI Number Information
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NPI Number | 1447803861
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Entity Type | Organization
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Legal Business Name | MARIN PETCT IMAGING, LLC
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 4000 CIVIC CENTER DR STE 110
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City | SAN RAFAEL
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State | CA
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Zip | 94903-5232
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Country | US
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Telephone | 401-722-1494
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 CIVIC CENTER DR STE 110
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City | SAN RAFAEL
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State | CA
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Zip | 94903-5232
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Country | US
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Telephone | 415-722-1494
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | TAMMY KARMAN
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Credential |
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Telephone | 415-722-1494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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