Provider Demographics
NPI:1982080495
Name:MARIN CITY HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MARIN CITY HEALTH AND WELLNESS CENTER
Other - Org Name:MARIN FAMILY BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C,E,O
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYVON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:415-339-8813
Mailing Address - Street 1:630 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1107
Mailing Address - Country:US
Mailing Address - Phone:415-339-8813
Mailing Address - Fax:415-339-8814
Practice Address - Street 1:880 LAS GALLINAS AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3437
Practice Address - Country:US
Practice Address - Phone:415-339-8813
Practice Address - Fax:415-339-8814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIN CITY HEALTH AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing