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Organization
MARIN HEALTHCARE DISTRICT
Active
Organization
MARIN HEALTHCARE DISTRICT
Active
Other names
Marin Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
LEE DOMANICO (CEO)
(415) 464-2090
Entity
Organization
Contact information
Practice address
1341 S ELISEO DR, SUITE 200, GREENBRAE, CA 94904-2000
(415) 464-8169
(415) 464-8177
Mailing address
PO BOX 45094, SAN FRANCISCO, CA 94145-0094
(415) 464-2090
(415) 464-2094
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS440A
MEDICARE GROUP PTAN
CA
Enumeration date
02/10/2012
Last updated
10/31/2013
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