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General NPI Number Information
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NPI Number | 1467818633
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Entity Type | Organization
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Legal Business Name | MARIN BRAIN INJURY NETWORK
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 1132 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-1019
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Country | US
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Telephone | 415-461-6771
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Fax | 415-461-8406
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Provider Business Mailing Address
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Address Line | 1132 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-1019
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Country | US
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Telephone | 415-461-6771
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Fax | 415-461-8406
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA GILL
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Credential |
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Telephone | 415-461-6771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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