Dominique Bazanos, LIFESTYLE COACH

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

732807 Issued in CA

Practice address

350 Terracina Blvd
Education Department
Redlands, CA 92373

Phone

(909) 335-5501

NPI assigned

Dec 15, 2023

Sex

Female

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

State licenses

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

{
    "created_epoch": "1702598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1407624711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 TERRACINA BLVD",
            "address_2": "EDUCATION DEPARTMENT",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92373",
            "telephone_number": "909-335-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 TERRACINA BLVD",
            "address_2": "EDUCATION DEPARTMENT",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92373",
            "telephone_number": "909-335-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZANOS",
        "first_name": "DOMINIQUE",
        "credential": "LIFESTYLE COACH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "732807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharita R Bates
• Kristin Batla, PA-C
• Jessica A Batterson, MSN, RN, FNP-BC
• Devon Nicole Baumbach, CCC-SLP
• Jessica Abrenio Bautista, D.D.S.
• Julie Bazzo, PSYD
• Kristen Beall
• Allison Beard
• Pat M Beaupre, PHD
• Beaver Medical Group LP (Beaver Medical Group - Internal)

• Community Health Registered Nurse in Redlands, CA
• Providers in Redlands, CA by specialty
• Community Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.