Provider Demographics
NPI:1083014153
Name:BERGEN, LAUREN (CSBE, CSBD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:BERGEN
Suffix:
Gender:F
Credentials:CSBE, CSBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 CALVIN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6537
Mailing Address - Country:US
Mailing Address - Phone:818-371-3142
Mailing Address - Fax:
Practice Address - Street 1:6321 CALVIN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6537
Practice Address - Country:US
Practice Address - Phone:818-371-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula