Provider Demographics
NPI:1952776759
Name:LACOMBE, JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E ALESSANDRO BLVD STE 9A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5095
Mailing Address - Country:US
Mailing Address - Phone:951-780-3300
Mailing Address - Fax:951-672-9635
Practice Address - Street 1:191 E ALESSANDRO BLVD STE 9A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5095
Practice Address - Country:US
Practice Address - Phone:951-780-3300
Practice Address - Fax:951-672-9635
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical