Provider Demographics
NPI:1114810595
Name:MARTZ, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARTZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 E 31ST PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8393
Practice Address - Country:US
Practice Address - Phone:928-336-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-08-01
Deactivation Date:2025-06-02
Deactivation Code:
Reactivation Date:2025-08-01
Provider Licenses
StateLicense IDTaxonomies
AZR82028390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program