Provider Demographics
NPI:1346925302
Name:GLAMOURBRAIN MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:GLAMOURBRAIN MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:GARCIA ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-904-4296
Mailing Address - Street 1:7321 ASPIRE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1183
Mailing Address - Country:US
Mailing Address - Phone:702-518-3533
Mailing Address - Fax:
Practice Address - Street 1:7321 ASPIRE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1183
Practice Address - Country:US
Practice Address - Phone:702-518-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty