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NPI Code Detail

MEDICARE: MR. JAMES PHILIP RIDDEL JR. RN, MS, CPNP

MEDICARE: MR. JAMES PHILIP RIDDEL JR. RN, MS, CPNP
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
1363L00000XNurse PractitionerRN478430 NP9272CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NP0092720OTHERCAMEDI-CAL PROVIDER

General Provider Information

NPI Number : 1942200928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES PHILIP RIDDEL JR. RN, MS, CPNP
Provider Business Mailing Address
First Line : 290 VERNON ST
Second Line :
City : OAKLAND
State : CA
Zip : 94610-4131
Country : US
Telephone Number : 510-451-3818
Fax Number :
Provider Business Practice Location Address
First Line : 747 52ND ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1809
Country : US
Telephone Number : 510-428-3853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/08/2007

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