Healthcare Provider Details

I. General information

NPI: 1730694027
Provider Name (Legal Business Name): DRAKIRAH L DEICHERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DRAKIRAH L GLENN

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date: 05/02/2021
Reactivation Date: 01/10/2025

III. Provider practice location address

2025 E 7TH ST
LONG BEACH CA
90804-4590
US

IV. Provider business mailing address

2025 E 7TH ST
LONG BEACH CA
90804-4590
US

V. Phone/Fax

Practice location:
  • Phone: 562-284-0108
  • Fax:
Mailing address:
  • Phone: 562-625-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: