Healthcare Provider Details
I. General information
NPI: 1659194116
Provider Name (Legal Business Name): EPIC BRAIN CENTERS - LUU PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/04/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2017 PINTO LN
LAS VEGAS NV
89106-4018
US
IV. Provider business mailing address
2017 PINTO LN
LAS VEGAS NV
89106-4018
US
V. Phone/Fax
- Phone: 702-333-2620
- Fax:
- Phone: 775-227-0455
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0301X |
| Taxonomy | Brain Injury Medicine (Psychiatry & Neurology) Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 202D00000X |
| Taxonomy | Integrative Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
VU
LUU
Title or Position: MANAGER / OWNER
Credential: MD
Phone: 702-292-3931