NPIMap

Organization Active NPI

Marin Healthcare District

  • Family Medicine Physician
  • Sausalito, CA
National Provider Identifier
1942573555
Registry record updated Feb 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARIN HEALTHCARE DISTRICT
Practice address
111 Second St
Sausalito, CA 94965-2526
Phone
(415) 332-2600
Fax
(415) 332-2610
NPI assigned
Feb 13, 2012
Last updated
Feb 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2012

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

111 Second St
Sausalito, CA 94965-2526

Mailing address

100 Drakes Landing Rd # B
Suite 250
Greenbrae, CA 94904-2404
Phone (415) 464-2090

Other identifiers 1

IdentifierTypeStateIssuer
CS440AOtherCAMEDICARE GROUP PTAN

Other names 1

  • Soluna Sausalito Health Center Other name

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": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329091200000",
    "number": "1942573555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DRAKES LANDING RD # B",
            "address_2": "SUITE 250",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042404",
            "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": "111 SECOND ST",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949652526",
            "telephone_number": "415-332-2600",
            "fax_number": "415-332-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-13",
        "last_updated": "2012-02-13",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "CS440A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soluna Sausalito Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 13, 2012; 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.