Organization
MARIN HEALTHCARE DISTRICT
Active
Other names
San Rafael Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEE DOMANICO (CEO)
(415) 464-2090
Entity
Organization
Contact information
Practice address
706 D ST, SAN RAFAEL, CA 94901-3757
(415) 256-1980
(415) 256-1981
Mailing address
PO BOX 45094, SAN FRANCISCO, CA 94145-0094
(415) 464-2090
(415) 464-2094
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult 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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