Provider Demographics
NPI:1346026713
Name:DRAKE, DAVID (MS, ACSM-CEP, EIM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MS, ACSM-CEP, EIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 PALM ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3522
Mailing Address - Country:US
Mailing Address - Phone:805-550-1946
Mailing Address - Fax:
Practice Address - Street 1:1965 SANTA BARBARA AVE # 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4435
Practice Address - Country:US
Practice Address - Phone:805-550-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty