Provider Demographics
NPI:1225924947
Name:BRAIN WAVE PSYCHIATRY SERVICES, PC
Entity type:Organization
Organization Name:BRAIN WAVE PSYCHIATRY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:661-571-9838
Mailing Address - Street 1:4403 EDAM STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6875
Mailing Address - Country:US
Mailing Address - Phone:661-571-9838
Mailing Address - Fax:
Practice Address - Street 1:4403 EDAM STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-6875
Practice Address - Country:US
Practice Address - Phone:661-571-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty