Healthcare Provider Details

I. General information

NPI: 1366653479
Provider Name (Legal Business Name): JULIE ELIZABETH BERGHOFER RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 BROADLAWN DR
LOS ANGELES CA
90068
US

IV. Provider business mailing address

3855 BROADLAWN DR
LOS ANGELES CA
90068-1203
US

V. Phone/Fax

Practice location:
  • Phone: 323-876-9362
  • Fax: 323-876-9362
Mailing address:
  • Phone: 323-876-9362
  • Fax: 323-876-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: