Provider Demographics
NPI:1366507295
Name:COUNTY OF MARIN
Entity Type:Organization
Organization Name:COUNTY OF MARIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PRIVACY SECURITY OFCR
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-473-2531
Mailing Address - Street 1:20 N SAN PEDRO RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4188
Mailing Address - Country:US
Mailing Address - Phone:415-473-6948
Mailing Address - Fax:
Practice Address - Street 1:3230 KERNER BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4841
Practice Address - Country:US
Practice Address - Phone:415-473-2843
Practice Address - Fax:415-473-3080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MARIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-22
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2177Medicaid
CA2177Medicaid