Provider Demographics
NPI:1013292093
Name:DZVONICK, BRYAN (ND)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:DZVONICK
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20246
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-0246
Mailing Address - Country:US
Mailing Address - Phone:951-202-2340
Mailing Address - Fax:951-530-1637
Practice Address - Street 1:6860 BROCKTON AVE
Practice Address - Street 2:STE 6
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3821
Practice Address - Country:US
Practice Address - Phone:951-202-2340
Practice Address - Fax:951-530-1637
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-487175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath