Provider Demographics
NPI:1093150633
Name:MARTI, CARMEN (MSN FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MARTI
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:701 PALM DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2141
Mailing Address - Country:US
Mailing Address - Phone:818-859-0210
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 327
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2003
Practice Address - Country:US
Practice Address - Phone:310-573-8947
Practice Address - Fax:310-573-8952
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily