Provider Demographics
NPI:1356499255
Name:DRAKE, DOUGLAS A (PA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:27412 ENTERPRISE CIR W STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4801
Mailing Address - Country:US
Mailing Address - Phone:951-694-6367
Mailing Address - Fax:951-694-1428
Practice Address - Street 1:27412 ENTERPRISE CIR W STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4801
Practice Address - Country:US
Practice Address - Phone:951-694-6367
Practice Address - Fax:951-694-1428
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant