Healthcare Provider Details

I. General information

NPI: 1346630142
Provider Name (Legal Business Name): JOE DRAKE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 3RD ST
SAN FRANCISCO CA
94124-2311
US

IV. Provider business mailing address

5015 3RD ST
SAN FRANCISCO CA
94124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-1585
  • Fax: 415-822-6443
Mailing address:
  • Phone: 415-822-1585
  • Fax: 415-822-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: