Provider Demographics
NPI:1043082647
Name:SNICKARS, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SNICKARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SHAFFER RD BLDG 1
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5761
Mailing Address - Country:US
Mailing Address - Phone:831-400-8981
Mailing Address - Fax:831-466-9039
Practice Address - Street 1:1201 SHAFFER RD BLDG 1
Practice Address - Street 2:SUITE 1A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5761
Practice Address - Country:US
Practice Address - Phone:831-400-8981
Practice Address - Fax:831-466-9039
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker