Healthcare Provider Details

I. General information

NPI: 1619839230
Provider Name (Legal Business Name): LISA BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 BURBANK BLVD STE 520
TARZANA CA
91356-6687
US

IV. Provider business mailing address

5334 LINDLEY AVE UNIT 214
ENCINO CA
91316-2905
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-2673
  • Fax:
Mailing address:
  • Phone: 818-758-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: