Provider Demographics
NPI:1366819278
Name:MARIN HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:MARIN HEALTHCARE DISTRICT
Other - Org Name:SIRONA VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMANICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-464-2090
Mailing Address - Street 1:1100 S ELISEO DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2017
Mailing Address - Country:US
Mailing Address - Phone:415-464-5400
Mailing Address - Fax:415-464-5413
Practice Address - Street 1:100 DRAKES LANDING RD # B
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2404
Practice Address - Country:US
Practice Address - Phone:415-464-5400
Practice Address - Fax:415-464-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty