Healthcare Provider Details

I. General information

NPI: 1376987701
Provider Name (Legal Business Name): BRAINTEK INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 SORRENTO VALLEY BLVD SUITE 310
SAN DIEGO CA
92121-1436
US

IV. Provider business mailing address

3978 SORRENTO VALLEY BLVD SUITE 310
SAN DIEGO CA
92121-1436
US

V. Phone/Fax

Practice location:
  • Phone: 858-735-4888
  • Fax: 858-385-0222
Mailing address:
  • Phone: 858-735-4888
  • Fax: 858-385-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2457 BCN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2457 BCN
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2457 BCN
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2457 BCN
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2457 BCN
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2457 BCN
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number2457 BCN
License Number StateCA

VIII. Authorized Official

Name: MR. DENNIS MANESS
Title or Position: OWNER
Credential: PH.D.
Phone: 858-735-4888