Healthcare Provider Details

I. General information

NPI: 1508225004
Provider Name (Legal Business Name): MRS. KAREN K COMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 CHATEAU RIDGE RD
CASTLE ROCK CO
80108-8424
US

IV. Provider business mailing address

4319 CHATEAU RIDGE RD
CASTLE ROCK CO
80108-8424
US

V. Phone/Fax

Practice location:
  • Phone: 303-807-1019
  • Fax: 303-683-1527
Mailing address:
  • Phone: 303-807-1019
  • Fax: 303-683-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number364757391
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: