MEDICARE: JOHN A. DRIMMER PSY-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY22886	CA

General Provider Information

NPI Number	:	1437433018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. DRIMMER PSY-D

Provider Business Mailing Address
First Line	:	179 S BARRINGTON PL
Second Line	:	STE. B
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3305
Country	:	US
Telephone Number	:	310-491-1472
Fax Number	:	714-739-4008

Provider Business Practice Location Address
First Line	:	179 S BARRINGTON PL
Second Line	:	STE. B
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3305
Country	:	US
Telephone Number	:	310-491-1472
Fax Number	:	714-739-4008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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