Dominique Terrell Pettis

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2275 E. Cooley Dr
Colton, CA 92324

Phone

(909) 370-1777

Fax

(909) 370-1776

NPI assigned

Nov 26, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353888000000",
    "number": "1184968570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16519 WELSH CT",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553316",
            "telephone_number": "951-566-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 E. COOLEY DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "92324",
            "telephone_number": "909-370-1777",
            "fax_number": "909-370-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "DOMINIQUE",
        "middle_name": "TERRELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-26",
        "last_updated": "2012-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie G Perez
• Omarina Perkins
• Jennifer M. Peterson
• Kimberly Petrick, M.D.
• Arpineh Petrosyan, DO
• Eileen Pham
• Gregory Manh Pham, DDS, DO
• Mailan Dinh Pham, M.D.
• Thang Van Pham
• Thanh Pham

• Addiction (Substance Use Disorder) Counselor in Colton, CA
• Providers in Colton, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.