Basic Information
| Provider Information | |||||||||
| NPI: | 1346532314 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIN MEDICAL LABORATORIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 HILL RD STE B | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949474338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158987649 | ||||||||
| FaxNumber: | 4158980870 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 ANDRIEUX ST | ||||||||
| Address2: | |||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954766811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079355185 | ||||||||
| FaxNumber: | 7079355437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | PRASAD | ||||||||
| AuthorizedOfficialFirstName: | KEDAR | ||||||||
| AuthorizedOfficialMiddleName: | CHE | ||||||||
| AuthorizedOfficialTitleorPosition: | PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4152096017 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | CLF 1363 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.