Provider Demographics
NPI:1760537120
Name:DRYDEN, JAMES W (CPO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:DRYDEN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2312
Mailing Address - Country:US
Mailing Address - Phone:818-753-1316
Mailing Address - Fax:818-509-0451
Practice Address - Street 1:10711 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2312
Practice Address - Country:US
Practice Address - Phone:818-753-1316
Practice Address - Fax:818-509-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO00842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000330Medicaid
CA0243320001Medicare ID - Type Unspecified