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General NPI Number Information
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NPI Number | 1528093093
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Entity Type | Organization
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Legal Business Name | MARIN INDIVIDUAL PRACTICE ASSOCIATION
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 1401 LOS GAMOS DRIVE SUITE 140
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-479-7100
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Fax | 415-479-7137
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Provider Business Mailing Address
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Address Line | 1401 LOS GAMOS DRIVE SUITE 140
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-479-7100
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Fax | 415-479-7137
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | WOJTEK NOWAK
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Credential |
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Telephone | 415-884-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 041525
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License Number State | CA
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