Healthcare Provider Details

I. General information

NPI: 1740755404
Provider Name (Legal Business Name): ZACHARY HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 BALDWIN ST
SALINAS CA
93906-3681
US

IV. Provider business mailing address

456 DELA VINA AVE APT G1
MONTEREY CA
93940-3945
US

V. Phone/Fax

Practice location:
  • Phone: 916-729-3098
  • Fax:
Mailing address:
  • Phone: 831-313-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: