Provider Demographics
NPI:1366688434
Name:MARIN COUNTY HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:MARIN COUNTY HEALTH AND HUMAN SERVICES
Other - Org Name:MARIN COUNTY IMMUNIZATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PUBLIC HEALTH NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RN-PHN
Authorized Official - Phone:415-473-6891
Mailing Address - Street 1:899 NORTHGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3636
Mailing Address - Country:US
Mailing Address - Phone:415-473-6891
Mailing Address - Fax:415-473-6881
Practice Address - Street 1:899 NORTHGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3636
Practice Address - Country:US
Practice Address - Phone:415-473-6891
Practice Address - Fax:415-473-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 270575251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare