Provider Demographics
NPI:1578306494
Name:BRAINHEALTH MD LLC
Entity type:Organization
Organization Name:BRAINHEALTH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANIOLKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-747-9014
Mailing Address - Street 1:1323 NW 3RD TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7741
Mailing Address - Country:US
Mailing Address - Phone:305-951-5131
Mailing Address - Fax:239-351-2043
Practice Address - Street 1:428 DEL PRADO BLVD N STE 103
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2210
Practice Address - Country:US
Practice Address - Phone:239-747-9014
Practice Address - Fax:239-351-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty