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General NPI Number Information
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NPI Number | 1407393309
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Entity Type | Organization
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Legal Business Name | BRAIN RECONNECTION, INC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 1929 MAIN ST STE 103
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City | IRVINE
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State | CA
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Zip | 92614-6524
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Country | US
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Telephone | 949-307-6914
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Fax |
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Provider Business Mailing Address
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Address Line | 1929 MAIN ST STE 103
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City | IRVINE
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State | CA
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Zip | 92614-6524
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Country | US
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Telephone | 949-307-6914
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HELA M KAMMOUN
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Credential | OT
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Telephone | 949-307-6914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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