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NPI Code Detail

MEDICARE: BRAIN POWER MEDICAL CENTER LLC

MEDICARE: BRAIN POWER MEDICAL CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103TA0400XAddiction (Substance Use Disorder) Psychologist
3163WA0400XAddiction (Substance Use Disorder) Registered Nurse
4207RA0401XAddiction Medicine (Internal Medicine) Physician
52084P0802XAddiction Psychiatry Physician
6261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1407523251
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAIN POWER MEDICAL CENTER LLC
Provider Business Mailing Address
First Line : 3430 E FLAMINGO RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5070
Country : US
Telephone Number : 510-456-8143
Fax Number :
Provider Business Practice Location Address
First Line : 3430 E FLAMINGO RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5070
Country : US
Telephone Number : 510-456-8143
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : CRISTINE HERNANDEZ
Credential :
Telephone Number : 510-456-8143
Provider Enumeration Date : 08/27/2021
Last Update Date : 08/27/2021

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Directions to “BRAIN POWER MEDICAL CENTER LLC ” Practice Location

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