Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 18638 | CA |
NPI | 1063062461 |
---|---|
Provider Name | Ms. Lauren Nicole Berman |
First Address | Venice, CA 90291-5217 |
Second Address | Beverly Hills, CA 90211-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2019 |
Last Update Date | 17/09/2019 |