Healthcare Provider Details

I. General information

NPI: 1073363719
Provider Name (Legal Business Name): BERLYNE LOUISIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 SANTA MONICA BLVD STE 302
W HOLLYWOOD CA
90046-5969
US

IV. Provider business mailing address

8235 SANTA MONICA BLVD STE 302
W HOLLYWOOD CA
90046-5969
US

V. Phone/Fax

Practice location:
  • Phone: 323-366-2966
  • Fax:
Mailing address:
  • Phone: 323-366-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11031629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: