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General NPI Number Information
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NPI Number | 1699472183
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Entity Type | Organization
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Legal Business Name | BRAINIAC MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1007 E COOLEY DR STE 111
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City | COLTON
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State | CA
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Zip | 92324-3901
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Country | US
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Telephone | 909-429-3244
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Fax | 909-981-0821
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Provider Business Mailing Address
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Address Line | PO BOX 6080
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City | ANAHEIM
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State | CA
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Zip | 92816-0080
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Country | US
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Telephone | 951-382-6161
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Fax | 951-666-3501
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Authorized Official
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Title or Position | CFO
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Name | TAQIALDEEN ZAMIL
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Credential | NP
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Telephone | 951-382-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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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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