MEDICARE: JEAN LACOMBE PA-C

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	363AM0700X	Medical Physician Assistant	16666	CA

General Provider Information

NPI Number	:	1952776759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN LACOMBE PA-C

Provider Business Mailing Address
First Line	:	191 E ALESSANDRO BLVD STE 9A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-780-3300
Fax Number	:	951-672-9635

Provider Business Practice Location Address
First Line	:	191 E ALESSANDRO BLVD STE 9A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-780-3300
Fax Number	:	951-672-9635

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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