Provider Demographics
NPI:1669001137
Name:MARTIKYAN, SUZIE
Entity Type:Individual
Prefix:
First Name:SUZIE
Middle Name:
Last Name:MARTIKYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11948 BURBANK BLVD APT 16
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1824
Mailing Address - Country:US
Mailing Address - Phone:818-212-6772
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1907
Practice Address - Country:US
Practice Address - Phone:310-791-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5939213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery