Provider Demographics
NPI:1922303437
Name:MARIN COMMUNITY CLINIC
Entity Type:Organization
Organization Name:MARIN COMMUNITY CLINIC
Other - Org Name:MARIN COMMUNITY CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVASZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-798-3106
Mailing Address - Street 1:9 COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6118
Mailing Address - Country:US
Mailing Address - Phone:415-798-3106
Mailing Address - Fax:415-798-3180
Practice Address - Street 1:3110 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5411
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551104Medicare Oscar/Certification