Provider Demographics
NPI:1568753887
Name:VARESKO, DUSTIN ROY (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ROY
Last Name:VARESKO
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 1:1065 11TH TEE DR
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1823
Mailing Address - Country:US
Mailing Address - Phone:909-544-0170
Mailing Address - Fax:
Practice Address - Street 1:20601 W PAOLI LN
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736
Practice Address - Country:US
Practice Address - Phone:530-637-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine