1982080495 NPI number — MARIN CITY HEALTH AND WELLNESS CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982080495 NPI number — MARIN CITY HEALTH AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIN CITY HEALTH AND WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARIN FAMILY BIRTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982080495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 DRAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUSALITO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94965-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-339-8813
Provider Business Mailing Address Fax Number:
415-339-8814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 LAS GALLINAS AVE
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94903-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-339-8813
Provider Business Practice Location Address Fax Number:
415-339-8814
Provider Enumeration Date:
08/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MUHAMMAD
Authorized Official First Name:
JAYVON
Authorized Official Middle Name:
Authorized Official Title or Position:
C,E,O
Authorized Official Telephone Number:
415-339-8813

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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