| Madrone High School | |
|
150 Lovell Ave Rm Ma-105, Staff Rm And Counseling Rm San Rafael CA 94901-3966 | |
| (415) 444-5580 | |
| Not Available |
| Full Name | Madrone High School |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 150 Lovell Ave, San Rafael, California |
| Authorized Official Name and Position | Donald Bruce Blasky (CHIEF PROGRAM OFFICER) |
| Authorized Official Contact | 4157552311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madrone High School 171 Carlos Dr San Rafael CA 94903-2005 Ph: () - | Madrone High School 150 Lovell Ave Rm Ma-105, Staff Rm And Counseling Rm San Rafael CA 94901-3966 Ph: (415) 444-5580 |
| NPI Number | 1235383894 |
|---|---|
| Provider Enumeration Date | 11/10/2008 |
| Last Update Date | 08/02/2021 |
| Certification Date | 08/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235383894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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