Healthcare Provider Details

I. General information

NPI: 1609836543
Provider Name (Legal Business Name): ROBERT PAUL DRAKE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N GILBERT ST SUITE B
HEMET CA
92543
US

IV. Provider business mailing address

255 N GILBERT ST STE B1
HEMET CA
92543-4078
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-4386
  • Fax: 951-925-4947
Mailing address:
  • Phone: 951-652-4386
  • Fax: 951-925-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE26090
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: