MEDICARE: MR. LEVI AARON COMBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	26900	CA
2	225800000X	Recreation Therapist
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1275644718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEVI AARON COMBS

Provider Business Mailing Address
First Line	:	126 FOUNTAIN OAKS CIR APT 199
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3971
Country	:	US
Telephone Number	:	559-415-5399
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 MADISON AVE STE 6
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5070
Country	:	US
Telephone Number	:	916-388-3231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/17/2024

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