MEDICARE: BRAIN WELLNESS CENTER PC

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
1	2084P0800X	Psychiatry Physician	G31269	CA

General Provider Information

NPI Number	:	1902356082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	5401 NORRIS CANYON RD STE 304
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-837-1100
Fax Number	:	925-837-1112

Provider Business Practice Location Address
First Line	:	5401 NORRIS CANYON RD STE 304
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-837-1100
Fax Number	:	925-837-1112

Authorized Official
Title or Position	:	CENTER DIRECTOR
Name	:	ALI HASHEMIAN
Credential	:	PHD
Telephone Number	:	925-837-1100

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	02/28/2023

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