Provider Demographics
NPI:1902372469
Name:BRIONESGARCIA, JUAN EDWIN (RCP)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:EDWIN
Last Name:BRIONESGARCIA
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82820 MOUNT RILEY DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3893
Mailing Address - Country:US
Mailing Address - Phone:760-791-8555
Mailing Address - Fax:
Practice Address - Street 1:82820 MOUNT RILEY DRIVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203
Practice Address - Country:US
Practice Address - Phone:760-791-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31396227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered