Healthcare Provider Details

I. General information

NPI: 1669834826
Provider Name (Legal Business Name): BRANDON MCGUCKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE 1
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

18819 E ARMSTEAD ST
AZUSA CA
91702-4806
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-5000
  • Fax:
Mailing address:
  • Phone: 626-391-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: