Provider Demographics
NPI:1891826962
Name:LAURA DARBY, M.D., PC
Entity Type:Organization
Organization Name:LAURA DARBY, M.D., PC
Other - Org Name:ALTERNA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-320-2629
Mailing Address - Street 1:565 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3309
Mailing Address - Country:US
Mailing Address - Phone:415-320-2629
Mailing Address - Fax:415-408-3564
Practice Address - Street 1:565 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3309
Practice Address - Country:US
Practice Address - Phone:415-320-2629
Practice Address - Fax:415-408-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50985261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35809Medicare UPIN
CAZZZ28025ZMedicare ID - Type UnspecifiedPROVIDER NUMBER