Healthcare Provider Details

I. General information

NPI: 1821466772
Provider Name (Legal Business Name): MS. NATALIE ANNE BERTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

IV. Provider business mailing address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-6901
  • Fax:
Mailing address:
  • Phone: 949-643-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: