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General NPI Number Information
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NPI Number | 1659113173
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Entity Type | Organization
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Legal Business Name | MARIN PACIFIC MEDICAL GROUP
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1849 SAWTELLE BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90025-7013
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Country | US
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Telephone | 341-217-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 1935A ADDISON ST STE 200
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City | BERKELEY
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State | CA
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Zip | 94704-1101
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Country | US
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Telephone | 341-217-8411
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL JEFFREY ZIZMOR
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Credential | MD
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Telephone | 341-222-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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