Provider Demographics
NPI:1528598430
Name:MARIN ORIENTAL MEDICINE, INC.
Entity Type:Organization
Organization Name:MARIN ORIENTAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:SHEPHERD
Authorized Official - Last Name:REIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-498-0755
Mailing Address - Street 1:38 CALEDONIA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2117
Mailing Address - Country:US
Mailing Address - Phone:415-332-1013
Mailing Address - Fax:415-231-3086
Practice Address - Street 1:38 CALEDONIA ST STE 1
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2117
Practice Address - Country:US
Practice Address - Phone:415-332-1013
Practice Address - Fax:415-231-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7818171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265612436OtherNPI
1760667455OtherNPI