Jeffrey D Distelberg, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC37522 Issued in CA

Practice address

325 W Hospitality LN
Ste. #312
San Bernardino, CA 92408-3243

Phone

(909) 386-5500

Fax

(909) 386-5520

NPI assigned

Jun 27, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720285422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W HOSPITALITY LN",
            "address_2": "STE. #312",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083243",
            "telephone_number": "909-386-5500",
            "fax_number": "909-386-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W HOSPITALITY LN",
            "address_2": "STE. #312",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083243",
            "telephone_number": "909-386-5500",
            "fax_number": "909-386-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTELBERG",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC37522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Trinh Dinh
• Sophia Phi Phi Dinh, PHARMD
• Tien Ngoc Dinh, M.D.
• Reginald Marc Zapanta Dionisio
• Sean Dishaw, RAS
• Denise C. Dittemore, M.D.
• Diversified Biopharma Solutions, Inc (Diversified Clinical Laboratories)
• Divina Family Counseling Services
• Divine Truth Unity Fellowship Church, Inc (Divine Truth Unity Fellowship Church dba Rainbow Pride Youth Alliance)
• Debra L Dixon-Hudak

• Marriage & Family Therapist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.