MARIN COMMUNITY CLINIC (NPI# 1124021738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124021738 |
| Entity Type | Organization |
| Organization Name | MARIN COMMUNITY CLINIC |
| Practice Address |
250 Bon Air Rd Greenbrae CA 94904-1702 |
| Mailing Address |
300 Professional Center Dr Ste 311 Novato CA 94947-4334 |
| Practice Telephone | 4154481500 |
| Practice Fax Number | 4154614229 |
| Mailing Telephone | 4154481531 |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | TYRONE NAVARRO (CFO) |
| Authorized Official Telephone | 4154481531 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
1100366 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DHS LICENSE - GREENBRAE | 1100366 | 01 |
| CA | FHC11975 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780292912 | Marin Community Clinic | Clinic/Center | 1260 S Eliseo Dr Ste 201, Greenbrae, CA 94904-2009 | 2020-07-14 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1790788107 | Marin Community Clinic | Clinic/Center | 400 Professional Center Dr, Ste 424, Novato, CA 94947-4368 | 2005-05-31 |
| 1881057115 | Marin Community Clinic | Clinic/Center | 6090 Redwood Blvd, Novato, CA 94945-4569 | 2016-04-04 |
| 1922303437 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2011-01-13 |
| 1912220781 | Marin Community Clinic | Clinic/Center | 6090 Redwood Blvd, Suite D, Novato, CA 94945-4569 | 2010-03-09 |
| 1154503399 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2007-11-29 |
| 1932327343 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
| 1669690079 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
| 1912091018 | Marin Community Clinic | Clinic/Center | 5 Bon Air Rd, Larkspur, CA 94939-1143 | 2006-10-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MARIN COMMUNITY CLINICS | 9 Commercial Blvd Ste 100, Novato, CA 94949-6137 |
| Street Address |
250 BON AIR RD |
| City | GREENBRAE |
| State | CA |
| Zip Code | 94904-1702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588270474 | Jonathan Nguyen Trinh | Pharmacist | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2020-09-16 |
| 1437768082 | Maritza Saucedo Rosas | Registered Nurse | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2020-07-29 |
| 1093323669 | Caroline Kent | Social Worker | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2020-07-20 |
| 1275152415 | Lokyan Yu | Registered Nurse | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2020-04-08 |
| 1144852591 | Lana Mccutchan | Registered Nurse | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2020-02-04 |
| 1295381747 | Melissa Bermudez Rivers | Rehabilitation Practitioner | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2019-08-12 |
| 1245884873 | William Horton IIi | Counselor | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2019-07-31 |
| 1336705540 | Maneesha Priya Deo | Pharmacist | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2019-05-13 |
| 1922564624 | Signy Marie Toquinto | Nurse Practitioner | 250 Bon Air Rd, Greenbrae, CA 94904-1784 | 2019-02-18 |
| 1366918344 | Kim Dianne Wian | Registered Nurse | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2018-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295382372 | Stacey Nicole Drew | Occupational Therapist | 4 Ash Ave, Unit 10, Kentfield, CA 94904 | 2019-08-22 |
| 1154781631 | Harvey Sparks | Specialist/Technologist, Other | 350 Bon Air, Ste 100, Greenbrae, CA 94904 | 2016-02-26 |
| 1396120481 | Tamena Potts | Counselor | 1109 Sir Francis Drake, Kentfield, CA 94904 | 2015-07-30 |
| 1598014763 | Rupali Ray Chaudhuri | Nurse Practitioner | 1341 S. Eliseo Dr, Suite 200, Greenbrae, CA 94904 | 2012-09-04 |
| 1326304809 | Lucy Yingxin Zhang | Ophthalmology | 900 S Eliseo Dr Ste 102, Greenbrae, CA 94904 | 2012-04-09 |
| 1396073185 | Bonnie Louise Hoag | Marriage & Family Therapist | 905 Sir Francis Drake Blvd., Ste. F., Kentfield, CA 94904 | 2009-12-07 |
| 1801043880 | Alexander Vogel Uihlein | Internal Medicine | 900 S Eliseo Dr Ste 201, Greenbrae, CA 94904 | 2008-08-21 |
| 1649426115 | Marilyn Thatcher | Psychologist | 1010 Sir Francis Drake Blve, Ste. 103, Kentfield, CA 94904 | 2008-08-14 |
| 1205007598 | Sir Francis Drake Dental | Dentist | 919 Sir Francis Drake Blvd, Kentfield, CA 94904 | 2008-03-14 |
| 1841401734 | Rishi K Wadhwa | Neurological Surgery | 1100 S Eliseo Dr Ste 1, Greenbrae, CA 94904 | 2007-05-24 |
| Find all providers in zip 94904 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932327343 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
| 1669690079 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.