Organization
MARIN HEALTHCARE DISTRICT
Active
Other names
Sirona Vascular Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEE DOMANICO (CEO)
(415) 464-2090
Entity
Organization
Contact information
Practice address
1100 S ELISEO DR, SUITE 2A, GREENBRAE, CA 94904-2017
(415) 464-5400
(415) 464-5413
Mailing address
PO BOX 45094, SAN FRANCISCO, CA 94145-0094
(415) 464-2090
(415) 464-2094
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS440A
MEDICARE GROUP PTAN
CA
Enumeration date
11/02/2013
Last updated
11/02/2013
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