Provider Demographics
NPI:1285441501
Name:BRAIN X DYNAMICS LLC
Entity type:Organization
Organization Name:BRAIN X DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:LUCILA
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-697-0176
Mailing Address - Street 1:800 SE 4TH AVE STE 808A
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6497
Mailing Address - Country:US
Mailing Address - Phone:305-697-0176
Mailing Address - Fax:305-912-0574
Practice Address - Street 1:800 SE 4TH AVE STE 808A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6497
Practice Address - Country:US
Practice Address - Phone:305-697-0176
Practice Address - Fax:305-912-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty