Provider Demographics
NPI:1447515531
Name:JAMES W DRYDEN, CPO, INC.
Entity type:Organization
Organization Name:JAMES W DRYDEN, CPO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:818-753-1316
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000330Medicaid
CAGXC000330Medicaid