Healthcare Provider Details

I. General information

NPI: 1013130905
Provider Name (Legal Business Name): ROBERT LEWIS BERGER IMF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W. AVE. J SUITE C
LANCASTER CA
93534
US

IV. Provider business mailing address

535 CRANE BLVD.
LOS ANGELES CA
90065
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax: 661-729-8912
Mailing address:
  • Phone: 323-227-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 39482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: