Brainhealth Solutions, Inc. | |
3151 Airway Ave Bldg R Costa Mesa CA 92626-4607 | |
(949) 288-5377 | |
(774) 209-4466 |
Full Name | Brainhealth Solutions, Inc. |
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Speciality | Psychiatry & Neurology |
Location | 3151 Airway Ave Bldg R, Costa Mesa, California |
Authorized Official Name and Position | Robert G Bota (PRESIDENT) |
Authorized Official Contact | 2298150219 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Brainhealth Solutions, Inc. 30310 Rancho Viejo Rd San Juan Capistrano CA 92675-1576 Ph: (949) 288-5377 | Brainhealth Solutions, Inc. 3151 Airway Ave Bldg R Costa Mesa CA 92626-4607 Ph: (949) 288-5377 |
NPI Number | 1649815267 |
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Provider Enumeration Date | 11/07/2019 |
Last Update Date | 08/02/2022 |
Certification Date | 08/02/2022 |
Medicare PECOS PAC ID | 6204264278 |
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Medicare Enrollment ID | O20200325002622 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649815267 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Robert G Bota |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1407990773 PECOS PAC ID: 8527086297 Enrollment ID: I20090210000069 |
Provider Name | Connery Lee |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124294145 PECOS PAC ID: 6901951615 Enrollment ID: I20090902000140 |
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