Individual
TIMOTHY DUSHE' DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6600 W CHARLESTON BLVD STE 140, LAS VEGAS, NV 89146-1067
(702) 437-4673
Mailing address
4236 FAIRFAX CIR APT 4, LAS VEGAS, NV 89119-6840
(909) 215-1086
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NV
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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