MEDICARE: DRAKE FOODS

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	225700000X	Massage Therapist	69512	CA

General Provider Information

NPI Number	:	1588101497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAKE FOODS

Provider Business Mailing Address
First Line	:	1902 SAN PABLO DR
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-4822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 SAN PABLO DR
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-4822
Country	:	US
Telephone Number	:	760-870-7118
Fax Number	:

Authorized Official
Title or Position	:	SEC/TREAS
Name	:	STEVE HENDRICK
Credential	:
Telephone Number	:	760-613-1438

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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Directions to “DRAKE FOODS ” Practice Location

Language	Start Address	Practice Location

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