Healthcare Provider Details

I. General information

NPI: 1386822112
Provider Name (Legal Business Name): TALIVA DONLEY MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST.
FREMONT CA
94538-2299
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax: 510-498-2685
Mailing address:
  • Phone: 510-498-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301092053
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA89123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: