Healthcare Provider Details

I. General information

NPI: 1295367951
Provider Name (Legal Business Name): BRIANNA DOMBROSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N STAGE COACH LN
FALLBROOK CA
92028-1736
US

IV. Provider business mailing address

747 S MISSION RD
FALLBROOK CA
92088-7001
US

V. Phone/Fax

Practice location:
  • Phone: 760-385-3846
  • Fax:
Mailing address:
  • Phone: 760-385-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: