Bryce Jay Allen Gordon, ATC, MA, CES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

26242 Dimension Dr Ste 150
Lake Forest, CA 92630-7811

Phone

(831) 332-8838

NPI assigned

Aug 2, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1285289611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 AMATO",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926925144",
            "telephone_number": "831-332-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26242 DIMENSION DR STE 150",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307811",
            "telephone_number": "831-332-8838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 E Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Azusa",
            "state": "CA",
            "postal_code": "917022606",
            "country_code": "US",
            "telephone_number": "626-969-3434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "BRYCE",
        "middle_name": "JAY ALLEN",
        "name_prefix": "Mr.",
        "credential": "ATC, MA, CES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-02",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.