MEDICARE: MEDIPATH HEALTH CARE INC

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	207Q00000X	Family Medicine Physician	20A5769	CA

General Provider Information

NPI Number	:	1790950905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIPATH HEALTH CARE INC

Provider Business Mailing Address
First Line	:	1325 N ROSE DR
Second Line	:	SUITE 201
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3840
Country	:	US
Telephone Number	:	310-348-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 N ROSE DR
Second Line	:	SUITE 201
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3840
Country	:	US
Telephone Number	:	310-348-0500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD S DRAKE
Credential	:	D.O.
Telephone Number	:	310-348-5500

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	09/10/2013

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