Provider Demographics
NPI:1669837902
Name:CALIFORNIA BRAIN INSTITUTE INC
Entity Type:Organization
Organization Name:CALIFORNIA BRAIN INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-810-7403
Mailing Address - Street 1:3435 E THOUSAND OAKS BLVD
Mailing Address - Street 2:3789
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7901
Mailing Address - Country:US
Mailing Address - Phone:805-795-7656
Mailing Address - Fax:805-494-8621
Practice Address - Street 1:2100 LYNN RD STE 120
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8033
Practice Address - Country:US
Practice Address - Phone:805-795-7656
Practice Address - Fax:805-618-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112672174400000X
207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty