| Full Name | |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 706 D St, San Rafael, California |
| Authorized Official Name and Position | Lee Domanico (CEO) |
| Authorized Official Contact | 4154642090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 45094 San Francisco CA 94145-0094 Ph: (415) 464-2090 | 706 D St San Rafael CA 94901-3757 Ph: (415) 256-1980 |
| NPI Number | 1669745337 |
|---|---|
| Provider Enumeration Date | 02/10/2012 |
| Last Update Date | 10/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669745337 | NPI | - | NPPES |
| CS440A | Other | CA | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
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