Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003180316 |
---|---|
Provider Name | Jessica Berger |
First Address | Los Angeles, CA 90034-3710 |
Second Address | Los Angeles, CA 90034-3710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2012 |
Last Update Date | 05/03/2012 |