Provider Demographics
NPI:1356406649
Name:DAVIS MARTEN, RITA LAFAYE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:LAFAYE
Last Name:DAVIS MARTEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27096 FIELDING DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542
Mailing Address - Country:US
Mailing Address - Phone:510-551-5894
Mailing Address - Fax:
Practice Address - Street 1:700 ADELINE STREET
Practice Address - Street 2:WEST OAKLAND HEALTH COUNCIL
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94542
Practice Address - Country:US
Practice Address - Phone:510-835-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily