Organization
MARIN COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH UDALL (DIRECTOR OF PATIENT ACCOUNTS)
(415) 798-3106
Entity
Organization
Contact information
Practice address
400 PROFESSIONAL CENTER DR, STE 424, NOVATO, CA 94947-4368
(415) 448-1531
(415) 892-8732
Mailing address
9 COMMERCIAL BLVD, SUITE 103, NOVATO, CA 94949
(415) 798-3106
(415) 798-3180
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
1100491
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1100491
DHS LICENSE- NOVATO
CA
05
—
FHC70941
—
CA
Enumeration date
05/31/2005
Last updated
01/28/2016
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