Provider Demographics
NPI:1710277462
Name:DRAKE, MELISSA GEORGENSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GEORGENSON
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 SAN ROQUE ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-455-6500
Mailing Address - Fax:805-456-0635
Practice Address - Street 1:504 W PUEBLO ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-455-6500
Practice Address - Fax:805-456-0635
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138505207V00000X
CAA138505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty