Provider Demographics
NPI:1053515882
Name:MELTZER, BERT (PHD)
Entity type:Individual
Prefix:DR
First Name:BERT
Middle Name:
Last Name:MELTZER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78432 GLASTONBURY WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1949
Mailing Address - Country:US
Mailing Address - Phone:909-563-0252
Mailing Address - Fax:
Practice Address - Street 1:78432 GLASTONBURY WAY
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1949
Practice Address - Country:US
Practice Address - Phone:909-563-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 3577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL35770Medicare PIN