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General NPI Number Information
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NPI Number | 1215367792
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Entity Type | Individual
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Provider Name | ERIC SICKINGER D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 665 CAMINO DE LOS MARES STE 305
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2841
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Country | US
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Telephone | 949-388-1060
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Fax | 855-523-0512
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Provider Business Mailing Address
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Address Line | 41990 COOK ST STE F1006
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City | PALM DESERT
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State | CA
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Zip | 92211-6100
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Country | US
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Telephone | 760-636-1067
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Fax | 855-523-0512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 20A13043
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License Number State | CA
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