Provider Demographics
NPI:1467837328
Name:KIPERTS, MARGRIETA LEE
Entity Type:Individual
Prefix:
First Name:MARGRIETA
Middle Name:LEE
Last Name:KIPERTS
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 1:750 OTAY LAKES RD STE 1073
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6915
Mailing Address - Country:US
Mailing Address - Phone:619-651-9566
Mailing Address - Fax:
Practice Address - Street 1:2855 TELEGRAPH AVE STE 204
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1150
Practice Address - Country:US
Practice Address - Phone:619-651-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA123007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program