Organization
MARIN COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY CRUZ (MEDICAL STAFF COORDINATOR)
(415) 448-1579
Entity
Organization
Contact information
Practice address
250 BON AIR RD, GREENBRAE, CA 94904-1702
(415) 448-1500
(415) 798-3180
Mailing address
6090 REDWOOD BLVD, SUITE G, NOVATO, CA 94945-4569
(415) 448-1500
(415) 798-3180
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP11975F
—
CA
Enumeration date
04/23/2007
Last updated
06/10/2009
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