Healthcare Provider Details

I. General information

NPI: 1275565087
Provider Name (Legal Business Name): GEOFFREY V DREW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E AVE DE LOS ARBOLES STE 203
THOUSAND OAKS CA
91360-3017
US

IV. Provider business mailing address

430 E AVE DE LOS ARBOLES STE 203
THOUSAND OAKS CA
91360-3017
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-1015
  • Fax: 805-492-2035
Mailing address:
  • Phone: 805-492-1015
  • Fax: 805-492-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA44579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: