Provider Demographics
NPI:1447803861
Name:MARIN PETCT IMAGING, LLC
Entity Type:Organization
Organization Name:MARIN PETCT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-722-1494
Mailing Address - Street 1:4000 CIVIC CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5232
Mailing Address - Country:US
Mailing Address - Phone:415-722-1494
Mailing Address - Fax:
Practice Address - Street 1:4000 CIVIC CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5232
Practice Address - Country:US
Practice Address - Phone:401-722-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No293D00000XLaboratoriesPhysiological Laboratory