Provider Demographics
NPI:1871901157
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:239-867-4395
Mailing Address - Fax:239-217-3662
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:239-867-4395
Practice Address - Fax:239-217-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104654207L00000X
FLOS12519207P00000X, 207PT0002X, 207QA0401X, 208D00000X
207Q00000X, 261QP2300X, 261QR0200X, 261QS1000X, 261QU0200X
FLOS130072084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care