Provider Demographics
NPI:1780792523
Name:MARIN ENDOCRINE CARE & RESEARCH INC
Entity type:Organization
Organization Name:MARIN ENDOCRINE CARE & RESEARCH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-1780
Mailing Address - Street 1:900 SOUTH ELISEO DRIVE
Mailing Address - Street 2:#201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-461-1780
Mailing Address - Fax:415-461-7378
Practice Address - Street 1:900 SOUTH ELISEO DRIVE
Practice Address - Street 2:#201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-461-1780
Practice Address - Fax:415-461-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540997163W00000X
CA00G179390207RE0101X
CA00G353640207RE0101X
CA9726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G353640OtherGAUDIANI LICENSE
CA00G179390OtherBERNSTEIN LICENSE
CAGR0040590Medicaid
A40231Medicare UPIN
A46326Medicare UPIN
CAGR0040590Medicaid