Provider Demographics
NPI:1356779359
Name:MULDER & BAUMBACHER MDS INC.
Entity type:Organization
Organization Name:MULDER & BAUMBACHER MDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-924-3801
Mailing Address - Street 1:300 TAMAL PLZ STE 150
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1160
Mailing Address - Country:US
Mailing Address - Phone:415-924-2195
Mailing Address - Fax:415-924-3841
Practice Address - Street 1:300 TAMAL PLZ STE 150
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1160
Practice Address - Country:US
Practice Address - Phone:415-924-2195
Practice Address - Fax:415-924-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20951261QM0801X
CAG75410261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)