Healthcare Provider Details

I. General information

NPI: 1508339698
Provider Name (Legal Business Name): VINCENT DVORAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 BUSKIRK AVE STE 260
PLEASANT HILL CA
94523-4358
US

IV. Provider business mailing address

3478 BUSKIRK AVE STE 260
PLEASANT HILL CA
94523-4358
US

V. Phone/Fax

Practice location:
  • Phone: 925-943-9714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: