Healthcare Provider Details

I. General information

NPI: 1457095986
Provider Name (Legal Business Name): BREAKTHROUGH PSYCHOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7346 SUNGOLD AVE
EASTVALE CA
92880-9031
US

IV. Provider business mailing address

7346 SUNGOLD AVE
EASTVALE CA
92880-9031
US

V. Phone/Fax

Practice location:
  • Phone: 909-276-7720
  • Fax:
Mailing address:
  • Phone: 909-276-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JARED A DOEGEY
Title or Position: OWNER
Credential:
Phone: 909-276-7720