Healthcare Provider Details

I. General information

NPI: 1750860904
Provider Name (Legal Business Name): DAVID RICHARD DREW MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 04/23/2025
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

IV. Provider business mailing address

5330 SAN BERNARDINO ST
MONTCLAIR CA
91763-2952
US

V. Phone/Fax

Practice location:
  • Phone: 909-458-1350
  • Fax:
Mailing address:
  • Phone: 833-579-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number91497
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: