Marin Functional Medicine LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

MARIN FUNCTIONAL MEDICINE LLC

Practice address

22 Jules Dr
Novato, CA 94947-2015

Phone

(415) 846-1891

NPI assigned

Apr 11, 2023

Organization subpart

No

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

Authorized official

Name

Diane Robinson, MS, CDN, NBC-HWC

Title

Owner, Clinical Nutritionist

Phone

(415) 846-1891

Specialties & licenses 3

Addresses

Other names 1

• Marin Functional Nutrition Former legal business name

Locations

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1710672001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 JULES DR",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949472015",
            "telephone_number": "415-846-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 JULES DR",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949472015",
            "telephone_number": "415-846-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN FUNCTIONAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER, CLINICAL NUTRITIONIST",
        "authorized_official_telephone_number": "415-846-1891",
        "authorized_official_credential": "MS, CDN, NBC-HWC"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marin Functional Nutrition",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Marin Community Clinic
• Marin Cosmetic Surgery Center
• Marin Emergency Physicians Medical Group, Inc.
• Marin Eye Care
• Marin Family Therapy Center
• Marin Healthcare District
• Marin Healthcare District
• Marin Hospitalistmedicalgroup,Inc
• Marin Ipa
• Marin Medical Laboratories

• Nutritionist in Novato, CA
• Providers in Novato, CA by specialty
• Nutritionist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; 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.