Provider Demographics
NPI:1609639343
Name:CEREBRO WELLNESS EMPOWERMENT CENTER
Entity type:Organization
Organization Name:CEREBRO WELLNESS EMPOWERMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:602-888-3474
Mailing Address - Street 1:5223 1/2 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8707
Mailing Address - Country:US
Mailing Address - Phone:602-904-2277
Mailing Address - Fax:762-212-4347
Practice Address - Street 1:2750 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2605
Practice Address - Country:US
Practice Address - Phone:602-888-3474
Practice Address - Fax:762-212-4347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEREBRO WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder