Healthcare Provider Details

I. General information

NPI: 1174446173
Provider Name (Legal Business Name): ELIOT DRACA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 BURTON AVE
ROHNERT PARK CA
94928-3316
US

IV. Provider business mailing address

9 CARDINAL WAY APT 238
SANTA ROSA CA
95409-7138
US

V. Phone/Fax

Practice location:
  • Phone: 707-792-4700
  • Fax: 707-792-4537
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: