Provider Demographics
NPI:1891947214
Name:ARDEMA, MARTA BEATRIZ (MA)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:BEATRIZ
Last Name:ARDEMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35114 MESA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1937
Mailing Address - Country:US
Mailing Address - Phone:951-522-3695
Mailing Address - Fax:
Practice Address - Street 1:1669 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4405
Practice Address - Country:US
Practice Address - Phone:909-886-6737
Practice Address - Fax:909-881-3871
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAPSB94023870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor