Provider Demographics
NPI:1720805591
Name:MARIN COMMUNITY CLINIC
Entity type:Organization
Organization Name:MARIN COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FADOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-755-2581
Mailing Address - Street 1:9 COMMERCIAL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6118
Mailing Address - Country:US
Mailing Address - Phone:415-798-3133
Mailing Address - Fax:415-798-3104
Practice Address - Street 1:700 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2926
Practice Address - Country:US
Practice Address - Phone:415-798-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)