Healthcare Provider Details

I. General information

NPI: 1053545442
Provider Name (Legal Business Name): RIKKI SUZANNE MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIKKI SUZANNE UNRUH

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY STE 401
VAN NUYS CA
91405-5848
US

IV. Provider business mailing address

14624 SHERMAN WAY STE 401
VAN NUYS CA
91405-5848
US

V. Phone/Fax

Practice location:
  • Phone: 909-737-9460
  • Fax: 279-300-4104
Mailing address:
  • Phone: 909-737-9460
  • Fax: 279-300-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA113135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: