Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 20A13043 | CA |
NPI | 1215367792 |
---|---|
Provider Name | Dr. Eric Sickinger |
First Address | Palm Desert, CA 92211-6100 |
Second Address | San Clemente, CA 92673-2841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 17/03/2018 |