Healthcare Provider Details

I. General information

NPI: 1336982552
Provider Name (Legal Business Name): NICHOLAS CHRISTOPHER BERG MSN, RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4843 DEEBOYAR AVE
LAKEWOOD CA
90712-3353
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2561
  • Fax:
Mailing address:
  • Phone: 801-680-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95219682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: