Healthcare Provider Details

I. General information

NPI: 1104871631
Provider Name (Legal Business Name): ELIOT ROBERT DRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MARSHALL WAY
PLACERVILLE CA
95667-5706
US

IV. Provider business mailing address

1006 MARSHALL WAY
PLACERVILLE CA
95667
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-6430
  • Fax: 530-622-3957
Mailing address:
  • Phone: 530-622-6430
  • Fax: 530-622-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG42662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: