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3230 Kerner Blvd San Rafael CA 94901-4840 | |
| (415) 473-5053 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 3230 Kerner Blvd, San Rafael, California |
| Authorized Official Name and Position | Rosanna Lallana (COMPLIANCE/PRIVACY OFFICER) |
| Authorized Official Contact | 4154732087 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4158 San Rafael CA 94913-4158 Ph: (415) 473-5053 | 3230 Kerner Blvd San Rafael CA 94901-4840 Ph: (415) 473-5053 |
| NPI Number | 1881065332 |
|---|---|
| Provider Enumeration Date | 10/09/2015 |
| Last Update Date | 05/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881065332 | NPI | - | NPPES |
| 2177 | Medicaid | CA |
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