Provider Demographics
NPI:1063749455
Name:SUMMER DRAKE, D.O., INC.
Entity type:Organization
Organization Name:SUMMER DRAKE, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-790-2395
Mailing Address - Street 1:1818 VERDUGO BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1403
Mailing Address - Country:US
Mailing Address - Phone:818-790-2395
Mailing Address - Fax:818-790-6830
Practice Address - Street 1:1818 VERDUGO BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1403
Practice Address - Country:US
Practice Address - Phone:818-790-2395
Practice Address - Fax:818-790-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty