Provider Demographics
NPI:1023772449
Name:BERDISCHEWSKY, LILITH (FNP)
Entity type:Individual
Prefix:MS
First Name:LILITH
Middle Name:
Last Name:BERDISCHEWSKY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2533
Mailing Address - Country:US
Mailing Address - Phone:818-769-2247
Mailing Address - Fax:818-769-2249
Practice Address - Street 1:12215 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2533
Practice Address - Country:US
Practice Address - Phone:818-769-2247
Practice Address - Fax:818-769-2249
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner