Provider Demographics
NPI:1689108029
Name:GARCIA, BRANDEN JUAN (MD)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:JUAN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743067
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3067
Mailing Address - Country:US
Mailing Address - Phone:626-244-8200
Mailing Address - Fax:
Practice Address - Street 1:323 S HELIOTROPE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2914
Practice Address - Country:US
Practice Address - Phone:626-408-9800
Practice Address - Fax:800-656-0593
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1863622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology