Provider Demographics
NPI:1043859077
Name:BRILLIANT START WELLNESS
Entity Type:Organization
Organization Name:BRILLIANT START WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-408-7976
Mailing Address - Street 1:15644 POMERADO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15644 POMERADO RD STE 200
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2455
Practice Address - Country:US
Practice Address - Phone:619-408-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)