Healthcare Provider Details

I. General information

NPI: 1528972361
Provider Name (Legal Business Name): LAUREN BERRIATUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4632 2ND ST STE 120
DAVIS CA
95618-9445
US

IV. Provider business mailing address

4632 2ND ST STE 120
DAVIS CA
95618-9445
US

V. Phone/Fax

Practice location:
  • Phone: 310-734-0593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: