Healthcare Provider Details

I. General information

NPI: 1467919217
Provider Name (Legal Business Name): DR. CANDICE LOREN DOMONDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28765 SINGLE OAK DR STE 140
TEMECULA CA
92590-3661
US

IV. Provider business mailing address

28765 SINGLE OAK DR STE 140
TEMECULA CA
92590-3661
US

V. Phone/Fax

Practice location:
  • Phone: 951-552-1126
  • Fax: 951-552-1128
Mailing address:
  • Phone: 951-552-1126
  • Fax: 951-552-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: