Healthcare Provider Details

I. General information

NPI: 1184355141
Provider Name (Legal Business Name): BRAIN POWER MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E FLAMINGO RD STE 104
LAS VEGAS NV
89121-5070
US

IV. Provider business mailing address

3430 E FLAMINGO RD STE 104
LAS VEGAS NV
89121-5070
US

V. Phone/Fax

Practice location:
  • Phone: 702-920-8596
  • Fax:
Mailing address:
  • Phone: 702-920-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CRISTINE HERNANDEZ
Title or Position: CEO
Credential:
Phone: 510-456-8143