Provider Demographics
NPI:1053029579
Name:MARMOLEJO-DRAKE, ALBERT LEONARD
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:LEONARD
Last Name:MARMOLEJO-DRAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 DUCKHORN DR UNIT 1134
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1276
Mailing Address - Country:US
Mailing Address - Phone:661-496-6063
Mailing Address - Fax:
Practice Address - Street 1:3610 DUCKHORN DR UNIT 1134
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1276
Practice Address - Country:US
Practice Address - Phone:661-496-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker