Organization
MARIN COMMUNITY CLINIC
Active
Other names
San Rafael Dental Mobile van
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA SHIPP (CHIEF EXECUTIVE OFFICER)
(415) 475-4572
Entity
Organization
Contact information
Practice address
3110 KERNER BLVD, SAN RAFAEL, CA 94901-5411
(415) 448-1500
Mailing address
3110 KERNER BLVD, SAN RAFAEL, CA 94901-5411
(415) 448-1500
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/06/2024
Last updated
06/27/2025
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