NPIMap

Organization Active NPI

Marin City Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Sausalito, CA
National Provider Identifier
1932629334
Registry record updated Jun 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550000861 Issued in CA
Legal business name
MARIN CITY HEALTH AND WELLNESS CENTER
Practice address
630 Drake Ave
Sausalito, CA 94965-1107
Phone
(415) 339-8813
Fax
(415) 339-8813
NPI assigned
Jun 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2017

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

Authorized official

Name
Patricia Rodriguez
Title
Chief Operating Officer
Phone
(415) 339-8813

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 550000861 CA
Federally Qualified Health Center (FQHC) 261QF0400X 550000861 CA Primary

Addresses

Primary practice location

630 Drake Ave
Sausalito, CA 94965-1107

Mailing address

630 Drake Ave
Sausalito, CA 94965-1107
Phone (415) 339-8813

Other identifiers 1

IdentifierTypeStateIssuer
1285804948MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Marin City Health Wellness3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498521600000",
    "number": "1932629334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 DRAKE AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651107",
            "telephone_number": "415-339-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 DRAKE AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651107",
            "telephone_number": "415-339-8813",
            "fax_number": "415-339-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-27",
        "last_updated": "2017-06-27",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "415-339-8813"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "550000861",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285804948",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sausalito, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2017; 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.