Healthcare Provider Details

I. General information

NPI: 1851034961
Provider Name (Legal Business Name): VICTORIA SHEREE ST MARTIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3987
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3703
  • Fax: 951-784-3270
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75192
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: