Provider Demographics
NPI:1093280976
Name:NEUROSPA BRAIN REJUVENATION CENTER, INC.
Entity Type:Organization
Organization Name:NEUROSPA BRAIN REJUVENATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-705-9964
Mailing Address - Street 1:2121 E COAST HWY STE 260
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1932
Mailing Address - Country:US
Mailing Address - Phone:949-652-7301
Mailing Address - Fax:949-652-7301
Practice Address - Street 1:2121 E COAST HWY STE 260
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1932
Practice Address - Country:US
Practice Address - Phone:949-652-7301
Practice Address - Fax:949-652-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty