Marin City Health and Wellness Center

Primary specialty

Birthing Clinic/CenterTaxonomy code 261QB0400X

Legal business name

MARIN CITY HEALTH AND WELLNESS CENTER

Doing business as

Marin Family Birth Center

Practice address

880 Las Gallinas Ave
Suite #1
San Rafael, CA 94903-3437

Phone

(415) 339-8813

Fax

(415) 339-8814

NPI assigned

Aug 6, 2015

Last updated

Aug 6, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

MARIN CITY HEALTH AND WELLNESS CENTERAs reported in NPPES

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

Authorized official

Name

Mrs. Jayvon Muhammad, LM

Title

C,E,O

Phone

(415) 339-8813

Specialties & licenses 1

Addresses

Other names 1

• Marin Family Birth Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982080495. Details of each certification follow.

• CCN 921026 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921026

Legal name

MARIN FAMILY BIRTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 2, 2018

Last certification

Feb 2, 2018

Ownership / control type

For profit – corporation

Facility address

880 Las Gallinas Ave, Ste 1
San Rafael, CA 94903

Part of

Marin City Health Wellness

Locations

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1982080495",
    "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": "880 LAS GALLINAS AVE",
            "address_2": "SUITE #1",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033437",
            "telephone_number": "415-339-8813",
            "fax_number": "415-339-8814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "enumeration_date": "2015-08-06",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "MUHAMMAD",
        "authorized_official_first_name": "JAYVON",
        "authorized_official_title_or_position": "C,E,O",
        "authorized_official_telephone_number": "415-339-8813",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LM"
    },
    "taxonomies": [
        {
            "code": "261QB0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Birthing",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marin Family Birth Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Marin Community Clinic

• Birthing Clinic/Center in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Birthing Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.