Provider Demographics
NPI:1063551000
Name:HUISA, BRANKO N (MD)
Entity type:Individual
Prefix:
First Name:BRANKO
Middle Name:N
Last Name:HUISA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRANKO
Other - Middle Name:NAHUM
Other - Last Name:HUISA-GARATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:44045 MARGARITA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2729
Mailing Address - Country:US
Mailing Address - Phone:951-462-4624
Mailing Address - Fax:951-462-4625
Practice Address - Street 1:44045 MARGARITA RD STE 106
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2729
Practice Address - Country:US
Practice Address - Phone:951-462-4624
Practice Address - Fax:951-462-4625
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005-04502084N0400X
CAA1085742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology