Healthcare Provider Details

I. General information

NPI: 1649432709
Provider Name (Legal Business Name): DREW EVAN COLLINS N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 GROSSMONT BLVD
LA MESA CA
91942-9026
US

IV. Provider business mailing address

8811 GROSSMONT BLVD
LA MESA CA
91942-9026
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-3838
  • Fax: 619-337-9008
Mailing address:
  • Phone: 619-440-3838
  • Fax: 619-337-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1332
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberND-83 / NDF-83
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: