Christin Dziadowicz, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95020587 Issued in CA

Practice address

901 San Bernardino Rd Ste 102
Upland, CA 91786-4988

Phone

(909) 579-6721

NPI assigned

Apr 5, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Synergy CT Surgery Partnership

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Upland, CA
  • NPI 1366711236
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1245971951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27475 YNEZ RD # 207",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SAN BERNARDINO RD STE 102",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864988",
            "telephone_number": "909-579-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIADOWICZ",
        "first_name": "CHRISTIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95020587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Granger Duvall, O.D.
• Dva Healthcare Renal Care Inc (Upland Dialysis)
• Dwaraknath P. Reddy, M.D.
• Joseph Dwyer
• Dynamic Performance Physical Therapy Inc (Kore Physical Therapy)
• Lily Elikplim Dzidula
• Jenmarie Christine Eadie, LCSW
• Eagle Universal LLC
• Dawn Earls
• Zohal Ebrahimi, DMD

• Family Nurse Practitioner in Upland, CA
• Providers in Upland, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.