Provider Demographics
NPI:1356832737
Name:DRAKE, JENNIFER BEZJAK (LAC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BEZJAK
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FRANCONIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5314
Mailing Address - Country:US
Mailing Address - Phone:917-673-7345
Mailing Address - Fax:
Practice Address - Street 1:109 BARTLETT ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3087
Practice Address - Country:US
Practice Address - Phone:917-673-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty