Provider Demographics
NPI:1700521762
Name:COMBS, LANETT
Entity Type:Individual
Prefix:
First Name:LANETT
Middle Name:
Last Name:COMBS
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 1:15385 SHEILA ST APT B
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-4552
Mailing Address - Country:US
Mailing Address - Phone:323-220-5039
Mailing Address - Fax:
Practice Address - Street 1:25400 ALESSANDRO BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4319
Practice Address - Country:US
Practice Address - Phone:951-570-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty