Healthcare Provider Details

I. General information

NPI: 1285935270
Provider Name (Legal Business Name): BRAIN AND SPINE SURGICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 W CHARLESTON BLVD #170-487
LAS VEGAS NV
89135
US

IV. Provider business mailing address

PO BOX 371331
LAS VEGAS NV
89137-1331
US

V. Phone/Fax

Practice location:
  • Phone: 702-482-7361
  • Fax: 702-482-7361
Mailing address:
  • Phone: 702-476-4326
  • Fax: 702-476-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MUNI SUBRAMANI
Title or Position: NEUROPHYSIOLOGIST & IONM CONSULTANT
Credential: PHD
Phone: 702-476-4326