Healthcare Provider Details

I. General information

NPI: 1861887481
Provider Name (Legal Business Name): MS. KALI DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SANTA ROSA AVE APT 1
SAN FRANCISCO CA
94112-1961
US

IV. Provider business mailing address

300 SANTA ROSA AVE APT 1
SAN FRANCISCO CA
94112-1961
US

V. Phone/Fax

Practice location:
  • Phone: 650-307-5254
  • Fax:
Mailing address:
  • Phone: 650-307-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: