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General NPI Number Information
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NPI Number | 1316580665
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Entity Type | Organization
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Legal Business Name | DOMINIQUE SANDERS NURSING CORPORATION
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 9431 HAVEN AVE STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5879
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Country | US
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Telephone | 725-234-2215
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Fax | 281-954-0056
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Provider Business Mailing Address
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Address Line | 9431 HAVEN AVE STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5879
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Country | US
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Telephone | 725-234-2215
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Fax | 281-954-0056
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Authorized Official
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Title or Position | PMHNP-BC
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Name | DOMINIQUE SANDERS
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Credential |
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Telephone | 725-234-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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