MEDICARE: BRAIN ENHANCEMENT INSTITUTE

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	106H00000X	Marriage & Family Therapist	18502	CA
2	208000000X	Pediatrics Physician	A72354	CA
3	235Z00000X	Speech-Language Pathologist	10919	CA
4	103G00000X	Clinical Neuropsychologist	G67163	CA

General Provider Information

NPI Number	:	1497003974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN ENHANCEMENT INSTITUTE

Provider Business Mailing Address
First Line	:	8055 W MANCHESTER AVE
Second Line	:	STE 720
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7960
Country	:	US
Telephone Number	:	310-305-1654
Fax Number	:	310-496-2957

Provider Business Practice Location Address
First Line	:	8055 W MANCHESTER AVE
Second Line	:	STE 720
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7960
Country	:	US
Telephone Number	:	310-305-1654
Fax Number	:	310-496-2957

Authorized Official
Title or Position	:	OWNER, EXECUTIVE DIRECTOR
Name	:	STEVEN ORENSTEIN
Credential	:
Telephone Number	:	310-305-1645

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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