Provider Demographics
NPI:1437459948
Name:PINCOMBE, IAN
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:PINCOMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 GILCREASE AVE
Mailing Address - Street 2:APT # 1237
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0199
Mailing Address - Country:US
Mailing Address - Phone:702-822-0293
Mailing Address - Fax:
Practice Address - Street 1:9303 GILCREASE AVE
Practice Address - Street 2:APT # 1237
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0199
Practice Address - Country:US
Practice Address - Phone:702-822-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVMI0323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner