Organization
MARIN CITY HEALTH AND WELLNESS CENTER
Active
Organization
MARIN CITY HEALTH AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA RODRIGUEZ (CHIEF OPERATING OFFICER)
(415) 339-8813
Entity
Organization
Contact information
Practice address
630 DRAKE AVE, SAUSALITO, CA 94965-1107
(415) 339-8813
(415) 339-8813
Mailing address
630 DRAKE AVE, SAUSALITO, CA 94965-1107
(415) 339-8813
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
550000861
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000861
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285804948
—
CA
Enumeration date
06/27/2017
Last updated
06/27/2017
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