MEDICARE: DR. BRYAN DZVONICK N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	ND-487	CA

General Provider Information

NPI Number	:	1013292093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN DZVONICK N.D.

Provider Business Mailing Address
First Line	:	PO BOX 20246
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92516-0246
Country	:	US
Telephone Number	:	951-202-2340
Fax Number	:	951-530-1637

Provider Business Practice Location Address
First Line	:	6860 BROCKTON AVE
Second Line	:	STE 6
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3821
Country	:	US
Telephone Number	:	951-202-2340
Fax Number	:	951-530-1637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/16/2014

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