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General NPI Number Information
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NPI Number | 1487549465
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Entity Type | Organization
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Legal Business Name | MARIN COMMUNITY CLINIC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1601 2ND ST STE 108
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2701
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Country | US
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Telephone | 415-448-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 9 COMMERCIAL BLVD STE 103
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City | NOVATO
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State | CA
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Zip | 94949-6118
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Country | US
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Telephone | 415-448-1500
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | BRENDA SHIPP
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Credential |
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Telephone | 415-475-4572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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