Provider Demographics
NPI:1073864161
Name:COMBS, HEIDI LEE (RRT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LEE
Last Name:COMBS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25590 PROSPECT AVE APT 13B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3145
Mailing Address - Country:US
Mailing Address - Phone:909-583-6130
Mailing Address - Fax:
Practice Address - Street 1:25590 PROSPECT AVE
Practice Address - Street 2:APT# 13B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3141
Practice Address - Country:US
Practice Address - Phone:909-583-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29466227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered