Provider Demographics
NPI:1598349060
Name:BRADEN CLINIC LLC
Entity type:Organization
Organization Name:BRADEN CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GARCIA IGUARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-317-1258
Mailing Address - Street 1:5068 ANNUNCIATION CIR UNIT 111
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9668
Mailing Address - Country:US
Mailing Address - Phone:954-743-6076
Mailing Address - Fax:
Practice Address - Street 1:5068 ANNUNCIATION CIR UNIT 111
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9668
Practice Address - Country:US
Practice Address - Phone:239-867-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health