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General NPI Number Information
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NPI Number | 1942573555
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Entity Type | Organization
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Legal Business Name | MARIN HEALTHCARE DISTRICT
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 111 SECOND ST
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City | SAUSALITO
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State | CA
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Zip | 94965-2526
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Country | US
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Telephone | 415-332-2600
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Fax | 415-332-2610
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Provider Business Mailing Address
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Address Line | 100 DRAKES LANDING RD # B SUITE 250
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City | GREENBRAE
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State | CA
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Zip | 94904-2404
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Country | US
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Telephone | 415-464-2090
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Fax | 415-464-2094
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Authorized Official
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Title or Position | CEO
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Name | LEE DOMANICO
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Credential |
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Telephone | 415-464-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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