Provider Demographics
NPI:1760852503
Name:MARIN WOMENS HEALTH
Entity Type:Organization
Organization Name:MARIN WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NP, PC
Authorized Official - Phone:415-233-3406
Mailing Address - Street 1:5 BON AIR RD
Mailing Address - Street 2:BLD D, SUITE 219
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1136
Mailing Address - Country:US
Mailing Address - Phone:415-233-3406
Mailing Address - Fax:415-924-1770
Practice Address - Street 1:5 BON AIR RD
Practice Address - Street 2:BLD D, SUITE 219
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1136
Practice Address - Country:US
Practice Address - Phone:415-233-3406
Practice Address - Fax:415-924-1770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIN WOMENS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201997207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty