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General NPI Number Information
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NPI Number | 1497003974
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Entity Type | Organization
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Legal Business Name | BRAIN ENHANCEMENT INSTITUTE
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 8055 W MANCHESTER AVE STE 720
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7960
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Country | US
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Telephone | 310-305-1654
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Fax | 310-496-2957
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Provider Business Mailing Address
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Address Line | 8055 W MANCHESTER AVE STE 720
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7960
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Country | US
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Telephone | 310-305-1654
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Fax | 310-496-2957
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Authorized Official
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Title or Position | OWNER, EXECUTIVE DIRECTOR
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Name | STEVEN ORENSTEIN
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Credential |
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Telephone | 310-305-1645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 18502
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A72354
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 10919
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | G67163
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License Number State | CA
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