Provider Demographics
NPI:1699844050
Name:MARINDALE MEDICAL THERAPY UNIT
Entity Type:Organization
Organization Name:MARINDALE MEDICAL THERAPY UNIT
Other - Org Name:CALIFORNIA CHILDREN'S SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-473-6893
Mailing Address - Street 1:3240 KERNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-473-6893
Mailing Address - Fax:415-473-6396
Practice Address - Street 1:850 DEL GANADO RD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2310
Practice Address - Country:US
Practice Address - Phone:415-479-2203
Practice Address - Fax:415-446-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00037FMedicaid