Individual provider Active NPI

Matthys Alejandro Moreno-Derks

  • Psychologist
  • San Jacinto, CA
National Provider Identifier
1790085363
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103
Phone
(951) 330-3100
Fax
(951) 350-1050
NPI assigned
Oct 28, 2010
Last updated
Mar 4, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103

Mailing address

1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103
Phone (951) 330-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210326002006 CA Practitioner - Clinical Psychologist 8921415530 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32259CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Moeller-Bertram Medical Corporation CurrentSince May 22, 2025 Accepting new patients
Tobias Moeller-Bertram MD Corporation CurrentSince Jul 12, 2021 Accepting new patients
Tobias Moeller-Bertram MD Corporation CurrentSince Jul 12, 2021 Accepting new patients
Center for Family Counseling Past Accepting new patients

Locations

17450 Main St
Ste D
Hesperia, CA 92345
Phone (760) 493-2929

81812 Doctor Carreon Blvd
Ste D
Indio, CA 92201
Phone (760) 347-7676

44630 Monterey Ave
Ste 100
Palm Desert, CA 92260
Phone (760) 340-4290

1133 N Palm Canyon Dr
Ste A
Palm Springs, CA 92262
Phone (760) 320-2200

36101 Bob Hope Dr
Ste A
Rancho Mirage, CA 92270
Phone (760) 321-1315

36101 Bob Hope Dr
Ste A1
Rancho Mirage, CA 92270
Phone (760) 321-1315

7065 Indiana Ave
Ste 100
Riverside, CA 92506
Phone (951) 476-0115

1695 S San Jacinto Ave
Ste A
San Jacinto, CA 92583
Phone (951) 330-3100

1695 S San Jacinto Ave
Ste Adf
San Jacinto, CA 92583
Phone (951) 330-3100

12830 Hesperia Rd
Ste C
Victorville, CA 92395
Phone (760) 684-8999

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1790085363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A-D&F",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "951-330-3100",
            "fax_number": "951-350-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A-D&F",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "951-330-3100",
            "fax_number": "951-350-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO-DERKS",
        "first_name": "MATTHYS",
        "middle_name": "ALEJANDRO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-28",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jacinto, CA

Sources for this page

Verify at the official NPI Registry.