Provider Demographics
NPI:1730921222
Name:DILLON, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 SANTA MONICA BLVD APT 121
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2185
Mailing Address - Country:US
Mailing Address - Phone:562-832-0898
Mailing Address - Fax:
Practice Address - Street 1:5640 SANTA MONICA BLVD APT 121
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2185
Practice Address - Country:US
Practice Address - Phone:562-832-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility