Provider Demographics
NPI:1629335021
Name:MARIN IMAGING
Entity Type:Organization
Organization Name:MARIN IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-454-1750
Mailing Address - Street 1:6 BRIDGE ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2040
Mailing Address - Country:US
Mailing Address - Phone:415-454-1750
Mailing Address - Fax:866-580-9020
Practice Address - Street 1:6 BRIDGE ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2040
Practice Address - Country:US
Practice Address - Phone:415-454-1750
Practice Address - Fax:866-580-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26700261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology