Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Revive Pathway

Organization General Practice Physician · NPI 1962117440

Revive Pathway is a General Practice Physician in El Cajon, California. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
3
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Practice location Address checks out

1240 Broadway
El Cajon, CA 92021-4994
Phone: (619) 841-1310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Use Disorder Rehabilitation Clinic/Center (primary) Taxonomy 261QR0405X
General Practice Physician Taxonomy 208D00000X
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X

Record details

NPI number1962117440
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Judson Lea — Coo · (619) 841-1310
NPI enumeratedJanuary 18, 2023
Last updated in NPPESMay 6, 2026
Certification dateMay 6, 2026
Mailing address6650 Gunpark Dr, Boulder, CO 80301-7002

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