Organization
PREVENTIVE MEDICAL CENTER OF MARIN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELSON M HAAS MD (OWNER MEDICAL DIRECTOR)
(415) 472-2343
Entity
Organization
Contact information
Practice address
4340 REDWOOD HWY STE AA, SAN RAFAEL, CA 94903-2121
(415) 472-2343
(415) 472-7636
Mailing address
4340 REDWOOD HWY STE A-22, SAN RAFAEL, CA 94903-2121
(415) 472-2343
(415) 472-7636
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222384942
BLUE SHIELD
—
Enumeration date
12/11/2006
Last updated
09/29/2023
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