Healthcare Provider Details

I. General information

NPI: 1013292093
Provider Name (Legal Business Name): BRYAN DZVONICK N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 BROCKTON AVE STE 6
RIVERSIDE CA
92506-3821
US

IV. Provider business mailing address

PO BOX 20246
RIVERSIDE CA
92516-0246
US

V. Phone/Fax

Practice location:
  • Phone: 951-202-2340
  • Fax: 951-530-1637
Mailing address:
  • Phone: 951-202-2340
  • Fax: 951-530-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: