Provider Demographics
NPI:1649432709
Name:COLLINS, DREW EVAN (ND)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:EVAN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 GROSSMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9026
Mailing Address - Country:US
Mailing Address - Phone:619-440-3838
Mailing Address - Fax:619-337-9008
Practice Address - Street 1:8811 GROSSMONT BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9026
Practice Address - Country:US
Practice Address - Phone:619-440-3838
Practice Address - Fax:619-337-9008
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1332175F00000X
CAND-83 / NDF-83302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1332OtherNATUROPATHIC MEDICAL LICENSE
CAND-83 / NDF-83OtherNATUROPATHIC MEDICAL LICENSE