Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 63774 | CA |
Y | 213EG0000X | General Practice | 63774 | CA |
NPI | 1003236886 |
---|---|
Provider Name | Dr. Jordan Combs |
First Address | Los Banos, CA 93635-3478 |
Second Address | Los Banos, CA 93635-3478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 17/11/2017 |