MEDICARE: EDWARD S. DRAKE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A5769	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A5769	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1629132592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD S. DRAKE D.O.

Provider Business Mailing Address
First Line	:	1325 N ROSE DR
Second Line	:	SUITE 201
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3840
Country	:	US
Telephone Number	:	714-203-1760
Fax Number	:	714-203-1765

Provider Business Practice Location Address
First Line	:	1325 N ROSE DR
Second Line	:	SUITE 201
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3840
Country	:	US
Telephone Number	:	714-203-1760
Fax Number	:	714-203-1765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	03/25/2015

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Directions to “ EDWARD S. DRAKE D.O.” Practice Location

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