NPIMap

Organization Active NPI

Paradigm San Francisco Marina

  • Psychiatric Residential Treatment Facility
  • San Rafael, CA
National Provider Identifier
1336832948
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
PARADIGM SAN FRANCISCO MARINA
Practice address
135 Marina Blvd
San Rafael, CA 94901-4224
Phone
(310) 457-6300
NPI assigned
May 30, 2023
Organization subpart
Yes
Parent organization
PARADIGM TREATMENT CENTERS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Authorized official

Name
Dustin Wagner
Title
Ceo
Phone
(310) 457-9008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X Primary

Addresses

Primary practice location

135 Marina Blvd
San Rafael, CA 94901-4224

Mailing address

12424 Wilshire Blvd Ste 800
Los Angeles, CA 90025-1035
Phone (310) 457-6300

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2286883Paradigm San Francisco Marina135 Marina Blvd, San Rafael, CA 94901Certificate of waiverAug 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Paradigm San Francisco Seaview House11 organizations share this tax ID, including this one
Part of
Paradigm San Francisco Seaview House

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1336832948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12424 WILSHIRE BLVD STE 800",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251035",
            "telephone_number": "310-457-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 MARINA BLVD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949014224",
            "telephone_number": "310-457-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADIGM SAN FRANCISCO MARINA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARADIGM TREATMENT CENTERS, LLC",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-457-9008"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.