Healthcare Provider Details

I. General information

NPI: 1538531330
Provider Name (Legal Business Name): DAIN ZYLSTRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 E MAIN ST
BARSTOW CA
92311-3234
US

IV. Provider business mailing address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-5700
  • Fax:
Mailing address:
  • Phone: 909-458-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A16351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: