NPI |
1265109011 |
|
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Organization Name Legal Business Name |
BRAIN POWER MEDICAL CENTER LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
3430 E FLAMINGO RD STE 104 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
LAS VEGAS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NV |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
891215070 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5104568143 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
8/27/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
2/8/2023 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
HERNANDEZ |
The fax number associated with the location
address of the provider being identified. |
Authorized Official First Name |
CRISTINE |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Title or Position |
MANAGING MEMBER |
The date that a record was last updated or changed. |
Authorized Official Telephone Number |
5104568143 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Healthcare Provider Taxonomy Code 1 |
2084B0040X |
The first name of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
2278P1005X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Healthcare Provider Taxonomy Code 3 |
261Q00000X |
|
Healthcare Provider Primary Taxonomy Switch 3 |
N |
|
Healthcare Provider Taxonomy Code 4 |
261QP2000X |
|
Healthcare Provider Primary Taxonomy Switch 4 |
N |
|
Healthcare Provider Taxonomy Code 5 |
261QR0401X |
|
Healthcare Provider Primary Taxonomy Switch 5 |
N |
|
Healthcare Provider Taxonomy Code 6 |
208D00000X |
|
Healthcare Provider Primary Taxonomy Switch 6 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 6 |
193200000X MULTI-SPECIALTY GROUP |
|
NPI Certification Date |
2/8/2023 |
|