Healthcare Provider Details

I. General information

NPI: 1083358790
Provider Name (Legal Business Name): THE BRAIN DISTRICT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23410 GRAND RESERVE DR STE 1102
KATY TX
77494-4984
US

IV. Provider business mailing address

8402 FULSHEAR RUN TRCE
RICHMOND TX
77406-2540
US

V. Phone/Fax

Practice location:
  • Phone: 346-387-6568
  • Fax: 346-387-6549
Mailing address:
  • Phone: 713-594-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY OSSO-RIVERA
Title or Position: PHYSICIAN
Credential: MD
Phone: 713-594-0677