Active NPI
Marta Beatriz Ardema, MA
- Clinical Psychologist
- San Bernardino, CA
National Provider Identifier
1891947214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSB94023870
- Practice address
- 1669 N E St
San Bernardino, CA 92405-4405 - Phone
- (909) 886-6737
- Fax
- (909) 881-3871
- NPI assigned
- Oct 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Psychologist | 103TC0700X | PSB94023870 | CA | Primary |
Addresses
Primary practice location
1669 N E St
San Bernardino, CA 92405-4405
Mailing address
35114 Mesa Grande Dr
Calimesa, CA 92320-1937
Phone (951) 522-3695
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB94023870 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1891947214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35114 MESA GRANDE DR",
"city": "CALIMESA",
"state": "CA",
"postal_code": "923201937",
"telephone_number": "951-522-3695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1669 N E ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924054405",
"telephone_number": "909-886-6737",
"fax_number": "909-881-3871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARDEMA",
"first_name": "MARTA",
"middle_name": "BEATRIZ",
"name_prefix": "Ms.",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-16",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB94023870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.