Healthcare Provider Details

I. General information

NPI: 1568753887
Provider Name (Legal Business Name): DUSTIN ROY VARESKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 W PAOLI LN
WEIMAR CA
95736
US

IV. Provider business mailing address

1065 11TH TEE DR
FIRCREST WA
98466-1823
US

V. Phone/Fax

Practice location:
  • Phone: 530-637-4025
  • Fax:
Mailing address:
  • Phone: 909-544-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60505068
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: