Coretta Brady

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

600 N Arrowhead Ave
San Bernardino, CA 92401-1164

Phone

(909) 963-5355

NPI assigned

Dec 10, 2015

Last updated

Oct 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Riverside

  dba Homeless Mentally Ill Outreach Treatment

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1598195562
  NPD
• Pacific Clinics

  • Community/Behavioral Health Agency
  • Ontario, CA
  • NPI 1902273923
  NPD (past)
• Step Up on Second Street Inc.

  dba Step Up on Second-San Bernardino

  • Community/Behavioral Health Agency
  • San Bernardino, CA
  • NPI 1285186353
  NPD (past)

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1538534987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10281 KIDD ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033469",
            "telephone_number": "951-715-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N ARROWHEAD AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011164",
            "telephone_number": "909-963-5355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12149 Pine St Apt 4",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CA",
            "postal_code": "906504262",
            "country_code": "US",
            "telephone_number": "562-250-2248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11741 Telegraph Rd",
            "address_purpose": "LOCATION",
            "city": "Santa Fe Springs",
            "state": "CA",
            "postal_code": "906703681",
            "country_code": "US",
            "telephone_number": "562-949-8455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADY",
        "first_name": "CORETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-10",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "15-06327",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kourtney Brackins, MD
• Emily Ruth Bradford-Lewis, FNP
• Jahonna M Bradford
• Tammy Bradshaw
• Christina L. Brady
• Rachelle Lynn Brady
• Keturah Braithwaite, PA-C
• Elena Brambila
• Margo Brandon
• Jim Branley

• Community Health Worker in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.