Organization
MARIN TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN FONG MBA (ASSOCIATE DIRECTOR)
(415) 457-3755
Entity
Organization
Contact information
Practice address
1466 LINCOLN AVE, SAN RAFAEL, CA 94901-2021
(415) 457-3755
(415) 457-9516
Mailing address
1466 LINCOLN AVE, SAN RAFAEL, CA 94901-2021
(415) 457-3755
(415) 457-9516
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
21-70
CA
261QP2300X
Primary Care Clinic/Center
110000417
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G265381
—
CA
05
—
CMM70602F
—
CA
05
—
EAP70602F
—
CA
05
—
ZZR11863F
—
CA
Enumeration date
04/23/2007
Last updated
03/10/2025
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