Provider Demographics
NPI:1205556081
Name:BRAL INTERNATIONAL MEDICAL INSTITUTE
Entity type:Organization
Organization Name:BRAL INTERNATIONAL MEDICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ BAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-478-9971
Mailing Address - Street 1:1601 E FLAMINGO RD STE 18
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5244
Mailing Address - Country:US
Mailing Address - Phone:702-478-9971
Mailing Address - Fax:702-478-9968
Practice Address - Street 1:1601 E FLAMINGO RD STE 19
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5244
Practice Address - Country:US
Practice Address - Phone:702-478-9971
Practice Address - Fax:702-478-9968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAL INTERNATIONAL MEDICAL INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty