Provider Demographics
NPI:1053545442
Name:MARTINEZ, RIKKI SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:RIKKI
Middle Name:SUZANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:SUZANNE
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7965 SIERRA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3329
Mailing Address - Country:US
Mailing Address - Phone:909-356-4459
Mailing Address - Fax:909-355-4261
Practice Address - Street 1:7965 SIERRA AVE STE E
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3329
Practice Address - Country:US
Practice Address - Phone:909-356-4459
Practice Address - Fax:909-355-4261
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053545442Medicaid