Healthcare Provider Details

I. General information

NPI: 1043082647
Provider Name (Legal Business Name): ERIC SNICKARS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SHAFFER RD BLDG 1 SUITE 1A
SANTA CRUZ CA
95060-5761
US

IV. Provider business mailing address

1201 SHAFFER RD BLDG 1 SUITE 1A
SANTA CRUZ CA
95060-5761
US

V. Phone/Fax

Practice location:
  • Phone: 831-400-8981
  • Fax: 831-466-9039
Mailing address:
  • Phone: 831-400-8981
  • Fax: 831-466-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: