Organization
MARIN HEALTHCARE DISTRICT
Active
Other names
Cardiovascular Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE DOMANICO (CEO)
(415) 464-2090
Entity
Organization
Contact information
Practice address
2 BON AIR RD, SUITE 100, LARKSPUR, CA 94939-1141
(415) 927-0666
(415) 927-6155
Mailing address
PO BOX 45094, SAN FRANCISCO, CA 94145-0094
(415) 464-2090
(415) 464-2094
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
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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