Healthcare Provider Details

I. General information

NPI: 1497003974
Provider Name (Legal Business Name): BRAIN ENHANCEMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 W MANCHESTER AVE STE 720
PLAYA DEL REY CA
90293-7960
US

IV. Provider business mailing address

8055 W MANCHESTER AVE STE 720
PLAYA DEL REY CA
90293-7960
US

V. Phone/Fax

Practice location:
  • Phone: 310-305-1654
  • Fax: 310-496-2957
Mailing address:
  • Phone: 310-305-1654
  • Fax: 310-496-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberG67163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number18502
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72354
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10919
License Number StateCA

VIII. Authorized Official

Name: STEVEN ORENSTEIN
Title or Position: OWNER, EXECUTIVE DIRECTOR
Credential:
Phone: 310-305-1645