Organization
BRADLEY JAY E. PROFESSIONAL CORPORATION
Active
Other names
Revive Men's Health, Revive Health
Organization subpart
No
Provider details
NPI number
Authorized official
JACKSON TEA MD (MANAGER)
(626) 429-0088
Entity
Organization
Contact information
Practice address
2501 E CHAPMAN AVE UNIT 107-C, FULLERTON, CA 92831-3132
(626) 429-0088
Mailing address
11278 LOS ALAMITOS BLVD UNIT 830, LOS ALAMITOS, CA 90720-3958
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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