Healthcare Provider Details

I. General information

NPI: 1114810595
Provider Name (Legal Business Name): RYAN MARTZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date: 06/02/2025
Reactivation Date: 08/01/2025

III. Provider practice location address

7200 E 31ST PL
YUMA AZ
85365-8393
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR82028
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR82028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: