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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