Marin City Health and Wellness Center

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

1601 2ND St
Suite 108
San Rafael, CA 94901-2712

Phone

(415) 339-8813

Fax

(415) 339-8814

NPI assigned

Apr 8, 2013

Organization subpart

No

Name

Muhammad Jayvon

Title

Executive Director

Phone

(415) 339-8813

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 4, 2016.

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1962845131",
    "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",
            "fax_number": "415-339-8814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 2ND ST",
            "address_2": "SUITE 108",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012712",
            "telephone_number": "415-339-8813",
            "fax_number": "415-339-8814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-08",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "JAYVON",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-339-8813"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Marcucci, PH.D.
• Mona Mardini
• Robin Margonie
• Marin Center for Independent Living
• Marin City Health and Wellness Center
• Marin City Health and Wellness Center
• Marin Community Clinic
• Marin Community Clinic
• Marin Community Clinic
• Marin Community Clinic

• All providers in San Rafael, CA
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.