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General NPI Number Information
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NPI Number | 1285441501
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Entity Type | Organization
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Legal Business Name | BRAIN X DYNAMICS LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 800 SE 4TH AVE STE 808A
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6497
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Country | US
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Telephone | 305-697-0176
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Fax | 305-912-0574
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Provider Business Mailing Address
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Address Line | 800 SE 4TH AVE STE 808A
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6497
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Country | US
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Telephone | 305-697-0176
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Fax | 305-912-0574
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Authorized Official
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Title or Position | CEO
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Name | DR. CLARA LUCILA ALVAREZ
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Credential | MD
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Telephone | 305-697-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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