Provider Demographics
NPI:1508225004
Name:COMBA, KAREN K
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:K
Last Name:COMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 CHATEAU RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8424
Mailing Address - Country:US
Mailing Address - Phone:303-807-1019
Mailing Address - Fax:303-683-1527
Practice Address - Street 1:4319 CHATEAU RIDGE RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8424
Practice Address - Country:US
Practice Address - Phone:303-807-1019
Practice Address - Fax:303-683-1527
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO364757391171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95320032Medicaid