Healthcare Provider Details

I. General information

NPI: 1578476065
Provider Name (Legal Business Name): FREE LIFE CARE MD GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
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: 818-807-7772
  • Fax:
Mailing address:
  • Phone: 818-807-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RIKKI S MARTINEZ
Title or Position: CEO
Credential: MD
Phone: 818-807-7772