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General NPI Number Information
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NPI Number | 1013292093
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Entity Type | Individual
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Provider Name | BRYAN DZVONICK N.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 6860 BROCKTON AVE STE 6
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City | RIVERSIDE
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State | CA
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Zip | 92506-3821
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Country | US
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Telephone | 951-202-2340
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Fax | 951-530-1637
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Provider Business Mailing Address
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Address Line | PO BOX 20246
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City | RIVERSIDE
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State | CA
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Zip | 92516-0246
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Country | US
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Telephone | 951-202-2340
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Fax | 951-530-1637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | ND-487
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License Number State | CA
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