Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A065465 | CA |
NPI | 1134326556 |
---|---|
Provider Name | Dr. Victor G Lacombe |
First Address | Santa Rosa, CA 95401-4330 |
Second Address | Santa Rosa, CA 95401-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 30/08/2012 |