Healthcare Provider Details

I. General information

NPI: 1356406649
Provider Name (Legal Business Name): RITA LAFAYE DAVIS MARTEN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE STREET WEST OAKLAND HEALTH COUNCIL
OAKLAND CA
94542
US

IV. Provider business mailing address

27096 FIELDING DRIVE
HAYWARD CA
94542
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax:
Mailing address:
  • Phone: 510-551-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number622239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: