Healthcare Provider Details

I. General information

NPI: 1497691273
Provider Name (Legal Business Name): JADAN LEE BRADLEY I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 W RAYMOND ST
COMPTON CA
90220-4459
US

IV. Provider business mailing address

885 W RAYMOND ST
COMPTON CA
90220-4459
US

V. Phone/Fax

Practice location:
  • Phone: 310-508-2562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY4423121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: