Magnolia Pediatrics of Marin, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

MAGNOLIA PEDIATRICS OF MARIN, INC.

Practice address

655 Redwood Hwy Frontage Rd Ste 216
Mill Valley, CA 94941-3055

Phone

(415) 380-8711

NPI assigned

Apr 3, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Suzanne Christie, MD

Title

President

Phone

(415) 380-8700

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1194287680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 REDWOOD HWY FRONTAGE RD STE 216",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 REDWOOD HWY FRONTAGE RD STE 216",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413055",
            "telephone_number": "415-380-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PEDIATRICS OF MARIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "CHRISTIE",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-380-8700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Hiu Wai Ma
• Tenning Maa, RPH
• Ian Macintosh
• Kellie Ann Magee, DDS
• Justin Mager, M.D.
• Jonathan David Mahrer, PH.D.
• Karine Florence, Isabelle Mallet
• Trina Gwendolyn Mann, DPT
• Nina Margolis, O.D.
• Maria Elena Marian, ND

• Pediatrics Physician in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.