Provider Demographics
NPI:1447341870
Name:ROBERT P DRAKE
Entity type:Organization
Organization Name:ROBERT P DRAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-652-4386
Mailing Address - Street 1:255 N GILBERT
Mailing Address - Street 2:BLDG B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-652-4386
Mailing Address - Fax:951-925-4948
Practice Address - Street 1:255 N GILBERT
Practice Address - Street 2:BLDG B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-652-4386
Practice Address - Fax:951-925-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000447261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001230Medicaid
CA05C0001230Medicaid