Provider Demographics
NPI:1407393309
Name:BRAIN RECONNECTION, INC
Entity Type:Organization
Organization Name:BRAIN RECONNECTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAMMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:949-307-6914
Mailing Address - Street 1:1929 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6524
Mailing Address - Country:US
Mailing Address - Phone:949-307-6914
Mailing Address - Fax:
Practice Address - Street 1:1929 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6524
Practice Address - Country:US
Practice Address - Phone:949-307-6914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty