Provider Demographics
NPI:1851801443
Name:ZYWICKI, ERIC
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:ZYWICKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5258
Mailing Address - Country:US
Mailing Address - Phone:493-039-8119
Mailing Address - Fax:760-216-5791
Practice Address - Street 1:570 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1405
Practice Address - Country:US
Practice Address - Phone:949-303-9811
Practice Address - Fax:760-216-5791
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007578363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95007578Medicaid
CA95007578OtherBRN