Healthcare Provider Details

I. General information

NPI: 1548346083
Provider Name (Legal Business Name): JENNIFER BETH NEWCOMBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROCKTON AVE
RIVERSIDE CA
92501-4068
US

IV. Provider business mailing address

7688 BELPINE PL
RANCHO CUCAMONGA CA
91730-6716
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-8020
  • Fax:
Mailing address:
  • Phone: 909-944-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: