Healthcare Provider Details

I. General information

NPI: 1083553416
Provider Name (Legal Business Name): JEREMIAH JAMES DICKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 SOQUEL AVE
SANTA CRUZ CA
95062-7805
US

IV. Provider business mailing address

5300 SOQUEL AVE
SANTA CRUZ CA
95062-7805
US

V. Phone/Fax

Practice location:
  • Phone: 831-540-4141
  • Fax: 831-424-4425
Mailing address:
  • Phone: 831-540-4141
  • Fax: 831-424-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: