Healthcare Provider Details

I. General information

NPI: 1982937892
Provider Name (Legal Business Name): RACHAEL D BERG-MARTINEZ PH.D., PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S OLD SPRINGS RD STE 135
ANAHEIM CA
92808-1285
US

IV. Provider business mailing address

160 S OLD SPRINGS RD STE 135
ANAHEIM CA
92808-1285
US

V. Phone/Fax

Practice location:
  • Phone: 657-215-7374
  • Fax:
Mailing address:
  • Phone: 657-215-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019003
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: