Provider Demographics
NPI:1346472032
Name:DRAKE, RACHAEL M (RD)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:M
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:M
Other - Last Name:WILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
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:805-215-9524
Mailing Address - Fax:
Practice Address - Street 1:756 PALM ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3522
Practice Address - Country:US
Practice Address - Phone:805-215-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered