Provider Demographics
NPI:1174040802
Name:MARTINEZ BERBER, MARIA AZUCENA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:AZUCENA
Last Name:MARTINEZ BERBER
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 1:1905 BUSINESS CENTER DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3460
Mailing Address - Country:US
Mailing Address - Phone:909-289-1041
Mailing Address - Fax:
Practice Address - Street 1:1905 BUSINESS CENTER DR UNIT 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-289-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1067749OtherDRIVER LICENSE