Bradley Jay E. Professional Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BRADLEY JAY E. PROFESSIONAL CORPORATION

Doing business as

Revive Health
Revive Men's Health

Practice address

2501 E Chapman Ave Unit 107-C
Fullerton, CA 92831-3132

Phone

(626) 429-0088

NPI assigned

Jun 3, 2024

Organization subpart

No

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

Authorized official

Name

Jackson Tea, MD

Title

Manager

Phone

(626) 429-0088

Specialties & licenses 1

Addresses

Other names 2

• Revive Health Doing business as
• Revive Men's Health Doing business as

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

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1689415911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11278 LOS ALAMITOS BLVD UNIT 830",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 E CHAPMAN AVE UNIT 107-C",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928313132",
            "telephone_number": "626-429-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY JAY E. PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-03",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "TEA",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "626-429-0088",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Men's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Corinne Boyd, OTR/L
• Jamie Boyd
• Tamiyah Jade Boykin
• John Joseph Boyko, D.C.
• Ehsan Bozorgi, LMFT
• Sheldon Leonard Bradley
• Shawntel Brailsford
• Deborah Helaine Branch, CD CERTIFICATION
• Brandy Brandon
• Joann Cherami Brannock, PHD

• Specialist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.