MARIN CITY HEALTH AND WELLNESS CENTER (NPI# 1962845131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962845131 |
| Entity Type | Organization |
| Organization Name | MARIN CITY HEALTH AND WELLNESS CENTER |
| Practice Address |
1601 2nd St Suite 108 San Rafael CA 94901-2712 |
| Mailing Address |
630 Drake Ave Sausalito CA 94965-1107 |
| Practice Telephone | 4153398813 |
| Practice Fax Number | 4153398814 |
| Mailing Telephone | 4153398813 |
| Mailing Fax Number | 4153398814 |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2016-03-04 |
| Authorized Official Name | MUHAMMAD JAYVON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4153398813 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
550000861 | CA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467810747 | Marin City Health and Wellness Center | Clinic/Center | 6301 3rd St, San Francisco, CA 94124-3501 | 2016-02-02 |
| 1932629334 | Marin City Health and Wellness Center | Clinic/Center | 630 Drake Ave, Sausalito, CA 94965-1107 | 2017-06-27 |
| 1457888299 | Marin City Health and Wellness Center | Clinic/Center | 880 Las Gallinas Ave, Suite 2, San Rafael, CA 94903 | 2017-05-11 |
| 1982080495 | Marin City Health and Wellness Center | Clinic/Center | 880 Las Gallinas Ave, Suite #1, San Rafael, CA 94903-3437 | 2015-08-06 |
| 1285804948 | Marin City Health and Wellness Center | Community/Behavioral Health | 630 Drake Ave, Sausalito, CA 94965-1107 | 2008-03-08 |
| Street Address |
1601 2ND ST SUITE 108 |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901-2712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578691648 | Jennifer Marie Buchanan | Dentist | 1601 2nd St, Suite 103 B, San Rafael, CA 94901-2712 | 2007-03-01 |
| 1831621879 | Stefanie Jean Bond | Counselor | 1601 2nd St, San Rafael, CA 94901-2712 | 2017-03-29 |
| 1568900900 | Melina Madrigal | Substance Abuse Rehabilitation Facility | 1601 2nd St, Suite 104, San Rafael, CA 94901-2712 | 2017-02-06 |
| 1720444078 | Michelle Denise Bonner | Counselor | 1601 2nd St, San Rafael, CA 94901-2712 | 2015-12-31 |
| 1063809929 | Samantha Maxwell | Counselor | 1601 2nd St, San Rafael, CA 94901-2712 | 2015-04-17 |
| 1588050918 | Christopher Nathan Pedraza | Social Worker | 1601 2nd St, 106, San Rafael, CA 94901-2712 | 2015-04-13 |
| 1295120970 | Ramin Behravan | Counselor | 1601 2nd St, #104, San Rafael, CA 94901-2712 | 2015-03-31 |
| 1558771527 | Melissa Anne Edwards | Counselor | 1601 2nd St, San Rafael, CA 94901-2712 | 2014-04-30 |
| 1861773723 | Robin Jane Grimm | Counselor | 1601 2nd St, Suite 104, San Rafael, CA 94901-2712 | 2011-09-06 |
| 1417238346 | Michael Wayne Leach | Counselor | 1601 2nd St, San Rafael, CA 94901-2712 | 2011-09-06 |
| 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 |
| 1922303437 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2011-01-13 |
| 1154503399 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2007-11-29 |
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| 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.