Healthcare Provider Details

I. General information

NPI: 1184549610
Provider Name (Legal Business Name): MRS. ALLISON ROSE DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 THE ALAMEDA
SAN JOSE CA
95126-2306
US

IV. Provider business mailing address

1147 GARFIELD AVE APT 18
SAN JOSE CA
95125-3116
US

V. Phone/Fax

Practice location:
  • Phone: 408-462-0794
  • Fax:
Mailing address:
  • Phone: 408-693-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: