MEDICARE: ERIN B COMBS FNP

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	363LF0000X	Family Nurse Practitioner	NP23067	CA

General Provider Information

NPI Number	:	1962755686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN B COMBS FNP

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-865-3105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 EASTLAKE AVE # NOR8302E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-2113
Country	:	US
Telephone Number	:	323-865-3105
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	04/10/2018

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