MEDICARE: BRAIN ENHANCEMENT INSTITUTE, INC.

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	2084P0800X	Psychiatry Physician	G67163	CA

General Provider Information

NPI Number	:	1659680742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN ENHANCEMENT INSTITUTE, INC.

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

Provider Business Practice Location Address
First Line	:	8055 W MANCHESTER AVE
Second Line	:	SUITE 720
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7960
Country	:	US
Telephone Number	:	310-402-2790
Fax Number	:

Authorized Official
Title or Position	:	CHEIF FINANCIAL OFFICER/C.F.O.
Name	:	WILLIAM A. SZYMAN
Credential	:
Telephone Number	:	310-402-2790

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/09/2010

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