Provider Demographics
NPI:1518163013
Name:KOEHLER, TARIN MOLLY (DO)
Entity type:Individual
Prefix:DR
First Name:TARIN
Middle Name:MOLLY
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NORTHGATE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2511
Mailing Address - Country:US
Mailing Address - Phone:415-226-9615
Mailing Address - Fax:415-805-7243
Practice Address - Street 1:1050 NORTHGATE DR STE 250
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2511
Practice Address - Country:US
Practice Address - Phone:152-269-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10764207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine