Healthcare Provider Details

I. General information

NPI: 1386574093
Provider Name (Legal Business Name): VIANEY M MARTINEZ LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 ARCHIBALD AVE STE 209
RANCHO CUCAMONGA CA
91730-5702
US

IV. Provider business mailing address

160 W SOUTH ST APT B
RIALTO CA
92376-6480
US

V. Phone/Fax

Practice location:
  • Phone: 840-999-8407
  • Fax:
Mailing address:
  • Phone: 840-999-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: