Healthcare Provider Details

I. General information

NPI: 1225761752
Provider Name (Legal Business Name): SHELBY RYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 818-336-7393
  • Fax:
Mailing address:
  • Phone: 818-336-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW123863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: