MEDICARE: JUSTIN BORN RADT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	RT1433630326	CA

General Provider Information

NPI Number	:	1750219531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN BORN RADT

Provider Business Mailing Address
First Line	:	1152 SONOMA AVE
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-5229
Country	:	US
Telephone Number	:	831-899-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 SONOMA AVE
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-5229
Country	:	US
Telephone Number	:	831-899-2436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ JUSTIN BORN RADT” Practice Location

Language	Start Address	Practice Location

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