Individual
BRANDON L DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12217 17TH ST, YUCAIPA, CA 92399-1580
(951) 318-6396
Mailing address
12217 17TH ST, YUCAIPA, CA 92399-1580
(951) 318-6396
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
95024908
CA
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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