Provider Demographics
NPI:1265236681
Name:BRADY, JAMES AUGUSTUS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:AUGUSTUS
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TECHNOLOGY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2191
Mailing Address - Country:US
Mailing Address - Phone:949-309-1378
Mailing Address - Fax:
Practice Address - Street 1:525 TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2191
Practice Address - Country:US
Practice Address - Phone:949-309-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician