MARIN COMMUNITY CLINIC (NPI# 1154503399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154503399 |
| Entity Type | Organization |
| Organization Name | MARIN COMMUNITY CLINIC |
| Practice Address |
3110 Kerner Blvd San Rafael CA 94901-5411 |
| Mailing Address |
9 Commercial Blvd Suite103 Novato CA 94949-6118 |
| Practice Telephone | 4155268500 |
| Practice Fax Number | 4155268553 |
| Mailing Telephone | 4154481500 |
| Mailing Fax Number | 4157983180 |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2016-01-06 |
| Authorized Official Name | MS. DEBORAH UDALL (DIRECTOR OF PATIENT ACCOUNTS) |
| Authorized Official Telephone | 4157983106 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
CA | Ambulatory Health Care Facilities |
| 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 |
| 1124021738 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2005-05-27 |
| 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 |
| 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 |
3110 KERNER BLVD |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901-5411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124132394 | Peter Allen Novota | Family Medicine | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2006-08-18 |
| 1457986762 | Erick Estrada | Dental Hygienist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2020-03-06 |
| 1003454489 | Emmeline Lui | Dental Hygienist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2019-12-16 |
| 1356804827 | Casey William Holden | Nurse Practitioner | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2019-04-10 |
| 1952844946 | Audrey Maureen Combs | Nurse Practitioner | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2016-11-23 |
| 1457893190 | Dena Ito | Acupuncturist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2016-11-11 |
| 1891161113 | Radka Varimezova Temnitzer | Dentist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2015-08-20 |
| 1316353717 | Joann Gruener | Dietary Manager | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2014-07-07 |
| 1508108820 | Anita Sree Kris | Dentist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2013-03-25 |
| 1134417850 | Neda Meshkin | Dentist | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2011-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1689101107 | Marin Family Recovery | Clinic/Center | 1209 Third St. Ste 4, San Rafael, CA 94901 | 2017-05-15 |
| 1376070011 | Tencia Beavers-sanchez | Counselor | 710 C Street Suite#8, Marin Outpatient&recoveryservices, Sanrafael, CA 94901 | 2017-05-12 |
| 1326584905 | Jamie Waterman | Emergency Medical Technician, Basic | 675 Sir Francis Drake Blvd, Kentfield, CA 94901 | 2017-01-06 |
| 1295270676 | Stephen Marks | Counselor | 900 Fifth Avenue, Suite 150, ; San Rafael, CA 94901 | 2016-12-21 |
| 1497299812 | Vesna Sturman | Psychologist | 712 D St Ste L, San Rafael, CA 94901 | 2016-12-05 |
| 1063955771 | Carol Dutton Hollenberg | Behavior Technician | 503 D St., San Rafael, CA 94901 | 2016-11-29 |
| 1083069447 | Bay Area Community Resources | Community/Behavioral Health | 103 Shoreline Parkway, San Rafael, CA 94901 | 2016-05-04 |
| Find all providers in zip 94901 | ||||
| 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 |
|---|---|---|---|---|
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1457888299 | Marin City Health and Wellness Center | Clinic/Center | 880 Las Gallinas Ave, Suite 2, San Rafael, CA 94903 | 2017-05-11 |
| 1417370032 | Ritter Center | Clinic/Center | 16 Ritter St, San Rafael, CA 94901-3323 | 2014-02-03 |
| 1962845131 | Marin City Health and Wellness Center | Clinic/Center | 1601 2nd St, Suite 108, San Rafael, CA 94901-2712 | 2013-04-08 |
| 1922303437 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2011-01-13 |
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| 1083221451 | Harmony Health Medical Clinic and Family Resource Center | Clinic/Center | 1930 N. Beale Road, Marysville, CA 95901-6915 | 2020-09-29 |
| 1235745928 | Community Medical Centers Inc | Clinic/Center | 747 E Channel St, Stockton, CA 95202-2628 | 2020-09-18 |
| 1760098503 | Chicago Clinica Medica Familiar Operated By Neighborhood Healthcare | Clinic/Center | 4022 Chicago Ave Ste A, Riverside, CA 92507-5340 | 2020-09-17 |
| 1164037149 | Camarena Health | Clinic/Center | 16645 Road 26, Madera, CA 93638-0830 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
| City | SAN RAFAEL |
| Zip Code | 94901 |
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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.