Individual
DONALD WAYNE MARLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RAS
Contact information
Practice address
603 D ST, SAN RAFAEL, CA 94901-3719
(415) 454-9444
Mailing address
603 D ST, SAN RAFAEL, CA 94901-3719
(415) 454-9444
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
03-097228
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M1105070241
BREINING INSTITUTE
CA
Enumeration date
11/24/2011
Last updated
11/24/2011
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