Provider Demographics
NPI:1528573615
Name:BRAINPOWER WELLNESS INSTITUTE NURSING CORPORATION
Entity Type:Organization
Organization Name:BRAINPOWER WELLNESS INSTITUTE NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAQIALDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-712-0711
Mailing Address - Street 1:1310 W STEWART DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3838
Mailing Address - Country:US
Mailing Address - Phone:714-712-0711
Mailing Address - Fax:657-224-4781
Practice Address - Street 1:1310 W STEWART DR STE 301
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3838
Practice Address - Country:US
Practice Address - Phone:714-712-0711
Practice Address - Fax:657-224-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
CA20560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health