Provider Demographics
NPI:1720667926
Name:BRANCH, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:BRANCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OAKDALE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1549
Mailing Address - Country:US
Mailing Address - Phone:330-601-9182
Mailing Address - Fax:
Practice Address - Street 1:28 OAKDALE AVE APT 2
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1549
Practice Address - Country:US
Practice Address - Phone:330-601-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide