Healthcare Provider Details

I. General information

NPI: 1831237098
Provider Name (Legal Business Name): ARDIS CAPPRICE MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/02/2024
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 OAKLAND BLVD STE 300
WALNUT CREEK CA
94596-8406
US

IV. Provider business mailing address

1407 OAKLAND BLVD STE 300
WALNUT CREEK CA
94596-8406
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-7617
  • Fax: 925-357-9490
Mailing address:
  • Phone: 719-357-7617
  • Fax: 925-357-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number144465
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number144465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: