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General NPI Number Information
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NPI Number | 1710551122
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Entity Type | Individual
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Provider Name | JASON C BRADEN
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Gender | Male
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 2213 BUCHANAN RD STE 107
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City | ANTIOCH
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State | CA
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Zip | 94509-4265
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Country | US
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Telephone | 510-417-6446
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Fax | 925-267-2578
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | PITTSBURG
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State | CA
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Zip | 94565-0085
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Country | US
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Telephone | 510-417-6446
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Fax | 925-778-4241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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