MEDICARE: DAVID DWYER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1578492138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DWYER

Provider Business Mailing Address
First Line	:	271 S 1ST ST
Second Line	:
City	:	DIXON
State	:	CA
Zip	:	95620-3401
Country	:	US
Telephone Number	:	916-840-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 FLORIN RD STE 75
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2535
Country	:	US
Telephone Number	:	916-840-7874
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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