MEDICARE: GLAMOURBRAIN MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1346925302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLAMOURBRAIN MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	7321 ASPIRE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1183
Country	:	US
Telephone Number	:	702-518-3533
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 ASPIRE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1183
Country	:	US
Telephone Number	:	702-518-3533
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JORGE ANGEL GARCIA ESTRADA
Credential	:
Telephone Number	:	702-904-4296

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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