1447356811 NPI number — MARIN MEDICAL LABORATORIES

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 1447356811 NPI number — MARIN MEDICAL LABORATORIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIN MEDICAL LABORATORIES
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:
Provider Other Organization Name Type Code:
6
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:
1447356811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 HILL ROAD SUITE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-209-6983
Provider Business Mailing Address Fax Number:
415-898-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 BON AIR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-925-7174
Provider Business Practice Location Address Fax Number:
415-461-7228
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRASAD
Authorized Official First Name:
KEDAR
Authorized Official Middle Name:
CHE
Authorized Official Title or Position:
PATHOLOGIST
Authorized Official Telephone Number:
415-209-6017

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  CLF316040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAB00787F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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