Healthcare Provider Details

I. General information

NPI: 1821300583
Provider Name (Legal Business Name): RYAN MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 3740 ACC
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y SREET ACC SUITE 3740
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8648
  • Fax:
Mailing address:
  • Phone: 916-734-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA118481
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA118481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: