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NPI Code Detail

MEDICARE: BRAIN POWER MEDICAL CENTER LLC

MEDICARE: BRAIN POWER MEDICAL CENTER 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
1103K00000XBehavior Analyst
2103TC0700XClinical Psychologist
3103TC2200XClinical Child & Adolescent Psychologist
41041C0700XClinical Social Worker
5106H00000XMarriage & Family Therapist
62084B0040XBehavioral Neurology & Neuropsychiatry Physician
7251S00000XCommunity/Behavioral Health Agency
8103T00000XPsychologist

General Provider Information

NPI Number : 1871263723
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAIN POWER MEDICAL CENTER LLC
Provider Business Mailing Address
First Line : 3430 E FLAMINGO RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5070
Country : US
Telephone Number : 510-456-8143
Fax Number :
Provider Business Practice Location Address
First Line : 3430 E FLAMINGO RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5070
Country : US
Telephone Number : 510-456-8143
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : CRISTINE HERNANDEZ
Credential :
Telephone Number : 510-456-8143
Provider Enumeration Date : 09/14/2021
Last Update Date : 06/09/2022

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Directions to “BRAIN POWER MEDICAL CENTER LLC ” Practice Location

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