Provider Demographics
NPI:1023484425
Name:MARIN HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:MARIN HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMANICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-464-2090
Mailing Address - Street 1:75 ROWLAND WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5037
Mailing Address - Country:US
Mailing Address - Phone:415-493-4944
Mailing Address - Fax:
Practice Address - Street 1:75 ROWLAND WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5037
Practice Address - Country:US
Practice Address - Phone:415-493-4944
Practice Address - Fax:415-493-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty