NPIMap

Organization Active NPI

Marin Healthcare District

Doing business as Sirona Vascular Center

  • Vascular Surgery Physician
  • Greenbrae, CA
National Provider Identifier
1891124632
Registry record updated Nov 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
MARIN HEALTHCARE DISTRICT
Doing business as
Sirona Vascular Center
Practice address
1100 S Eliseo Dr
Suite 2a
Greenbrae, CA 94904-2017
Phone
(415) 464-5400
Fax
(415) 464-5413
NPI assigned
Nov 2, 2013
Last updated
Nov 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2013

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

Authorized official

Name
Lee Domanico
Title
Ceo
Phone
(415) 464-2090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X Primary

Addresses

Primary practice location

1100 S Eliseo Dr
Suite 2a
Greenbrae, CA 94904-2017

Mailing address

PO Box 45094
San Francisco, CA 94145-0094
Phone (415) 464-2090

Other identifiers 1

IdentifierTypeStateIssuer
CS440AOtherCAMEDICARE GROUP PTAN

Other names 1

  • Sirona Vascular Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Marin Healthcare Disrict13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383350400000",
    "number": "1891124632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45094",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941450094",
            "telephone_number": "415-464-2090",
            "fax_number": "415-464-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S ELISEO DR",
            "address_2": "SUITE 2A",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042017",
            "telephone_number": "415-464-5400",
            "fax_number": "415-464-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A",
        "authorized_official_last_name": "DOMANICO",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-464-2090"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "CS440A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sirona Vascular Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2013; 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.