Healthcare Provider Details

I. General information

NPI: 1750371407
Provider Name (Legal Business Name): BARRY S DZINDZIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

IV. Provider business mailing address

3156 VISTA WAY SUITE 405
OCEANSIDE CA
92056-3622
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-2047
  • Fax:
Mailing address:
  • Phone: 760-439-6581
  • Fax: 760-439-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG18510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: