Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1164791935 |
---|---|
Provider Name | Mrs. Richelle Jeannine Drake |
First Address | Van Nuys, CA 91411-1418 |
Second Address | Van Nuys, CA 91411-1418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 22/12/2011 |