Provider Demographics
NPI:1982931606
Name:COMBS, DONNA L (LAC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:COMBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13015 W RANCHO SANTA FE BLVD APT 1148
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1725
Mailing Address - Country:US
Mailing Address - Phone:520-404-3836
Mailing Address - Fax:
Practice Address - Street 1:13065 W MCDOWELL RD STE B111
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6443
Practice Address - Country:US
Practice Address - Phone:623-777-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0930171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist