Healthcare Provider Details

I. General information

NPI: 1225778129
Provider Name (Legal Business Name): DOMINIQUE BYRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 MERIDIAN PKWY # 2
RIVERSIDE CA
92518-3035
US

IV. Provider business mailing address

14350 MERIDIAN PKWY # 2
RIVERSIDE CA
92518-3035
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA202047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: