Healthcare Provider Details

I. General information

NPI: 1386235299
Provider Name (Legal Business Name): ERIC BIGGANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

1512 APACHE DR UNIT A
CHULA VISTA CA
91910-8104
US

V. Phone/Fax

Practice location:
  • Phone: 619-368-5555
  • Fax:
Mailing address:
  • Phone: 619-368-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95212950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: