Provider Demographics
NPI:1831237098
Name:MARTIN, ARDIS CAPPRICE (MD)
Entity type:Individual
Prefix:DR
First Name:ARDIS
Middle Name:CAPPRICE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 OAKLAND BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8406
Mailing Address - Country:US
Mailing Address - Phone:719-357-7617
Mailing Address - Fax:925-357-9490
Practice Address - Street 1:1407 OAKLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8406
Practice Address - Country:US
Practice Address - Phone:719-357-7617
Practice Address - Fax:925-357-9490
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1444652084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14636239Medicaid
CO20009Medicare PIN
CO14636239Medicaid