Healthcare Provider Details

I. General information

NPI: 1598647497
Provider Name (Legal Business Name): BRANDON MANUEL JUAREZ GARCIA CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 TATONE ST
BOARDMAN OR
97818-8076
US

IV. Provider business mailing address

126 NE 3RD ST
BOARDMAN OR
97818-8001
US

V. Phone/Fax

Practice location:
  • Phone: 541-481-7212
  • Fax: 541-481-2020
Mailing address:
  • Phone: 541-969-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number114453
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: