| Preventive Medical Center Of Marin Inc | |
|
4340 Redwood Hwy Ste Aa San Rafael CA 94903-2121 | |
| (415) 472-2343 | |
| (415) 472-7636 |
| Full Name | Preventive Medical Center Of Marin Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4340 Redwood Hwy Ste Aa, San Rafael, California |
| Authorized Official Name and Position | Elson M Haas (OWNER MEDICAL DIRECTOR) |
| Authorized Official Contact | 4154722343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Preventive Medical Center Of Marin Inc 4340 Redwood Hwy Ste A-22 San Rafael CA 94903-2121 Ph: (415) 472-2343 | Preventive Medical Center Of Marin Inc 4340 Redwood Hwy Ste Aa San Rafael CA 94903-2121 Ph: (415) 472-2343 |
| NPI Number | 1912067828 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 09/29/2023 |
| Medicare PECOS PAC ID | 4688734445 |
|---|---|
| Medicare Enrollment ID | O20081201000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912067828 | NPI | - | NPPES |
| 222384942 | Other | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Elson Haas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740318112 PECOS PAC ID: 1153481080 Enrollment ID: I20081201000549 |
| Provider Name | Judy Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043420896 PECOS PAC ID: 2163672676 Enrollment ID: I20121018000344 |
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