Organization · NPI-2

Brain Longevity Center

Psychiatry & Neurology, Neurology · Thousand Oaks, CA

NPI number1750503603
StatusActive
Last updated in NPPESJul 25, 2007

Details

NPI
1750503603
Entity type
Organization (NPI-2)
Legal business name
Brain Longevity Center
Organization subpart
No
Enumeration date
May 2, 2007
Last updated
Jul 25, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084N0400X Psychiatry & Neurology, NeurologyG47623CAYes

Practice location

2100 Lynn Rd Ste 230
Thousand Oaks, CA 91360-8035

Phone 805-497-4500 · Fax 805-495-1717

Mailing address

2100 Lynn Rd Ste 230
Thousand Oaks, CA 91360-8035

Phone 805-497-4500 · Fax 805-495-1717

Authorized official

Lorne Sheldon Label
Medical Director
8054974500

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