Provider Demographics
NPI:1316555956
Name:SOMBARA, JEAN JHANPAT (LVN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JHANPAT
Last Name:SOMBARA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11166 KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-6330
Mailing Address - Country:US
Mailing Address - Phone:909-628-5379
Mailing Address - Fax:909-628-5379
Practice Address - Street 1:447 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4223
Practice Address - Country:US
Practice Address - Phone:909-628-5379
Practice Address - Fax:909-628-5379
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98357164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty