Provider Demographics
NPI:1083101000
Name:NOWASKIE, DUSTIN ZACHARY (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ZACHARY
Last Name:NOWASKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2534
Mailing Address - Country:US
Mailing Address - Phone:317-759-0926
Mailing Address - Fax:
Practice Address - Street 1:2278 W 29TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2534
Practice Address - Country:US
Practice Address - Phone:317-759-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083159A2084P0800X
390200000X
CA1792982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program