Provider Demographics
NPI:1154516383
Name:BRIGHTON VENTURES
Entity type:Organization
Organization Name:BRIGHTON VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRENALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-709-7941
Mailing Address - Street 1:23070 SISKIN CT
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5338
Mailing Address - Country:US
Mailing Address - Phone:909-825-8842
Mailing Address - Fax:909-825-8842
Practice Address - Street 1:1280 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3932
Practice Address - Country:US
Practice Address - Phone:909-953-6713
Practice Address - Fax:909-825-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13242251J00000X
CAGRAND TERRACE 24104343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251J00000XAgenciesNursing Care