Provider Demographics
NPI:1235569732
Name:BRAINEFIT LLC.
Entity Type:Organization
Organization Name:BRAINEFIT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUOHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-231-5858
Mailing Address - Street 1:324 MADSON PL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6599
Mailing Address - Country:US
Mailing Address - Phone:530-231-5858
Mailing Address - Fax:
Practice Address - Street 1:324 MADSON PL
Practice Address - Street 2:SUITE 150
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6599
Practice Address - Country:US
Practice Address - Phone:530-231-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service