Healthcare Provider Details

I. General information

NPI: 1588555833
Provider Name (Legal Business Name): MRS. ZVART DENTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 APOLLO ST STE 217
EL SEGUNDO CA
90245-4752
US

IV. Provider business mailing address

8082 YORKTOWN AVE APT 203
HUNTINGTON BEACH CA
92646-3151
US

V. Phone/Fax

Practice location:
  • Phone: 855-818-2218
  • Fax:
Mailing address:
  • Phone: 657-521-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: