Healthcare Provider Details

I. General information

NPI: 1124978689
Provider Name (Legal Business Name): BRITTANY JEAN DOMINICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

IV. Provider business mailing address

1508 BARTON RD # 236
REDLANDS CA
92373-1410
US

V. Phone/Fax

Practice location:
  • Phone: 909-747-7822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95335605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: