| Brainhealth Solutions, Inc. | |
|
3151 Airway Ave Bldg R Costa Mesa CA 92626-4607 | |
| (949) 288-5377 | |
| (774) 209-4466 |
| Full Name | Brainhealth Solutions, Inc. |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 11/07/2019 |
| Last Update Date | 08/02/2022 |
| Certification Date | 08/02/2022 |
| Medicare PECOS PAC ID | 6204264278 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407990773 PECOS PAC ID: 8527086297 Enrollment ID: I20090210000069 |
| Provider Name | Connery Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124294145 PECOS PAC ID: 6901951615 Enrollment ID: I20090902000140 |
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