Individual
CHAD R HICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAOD
Contact information
Practice address
2250 SOQUEL AVE, SANTA CRUZ, CA 95062-1402
(831) 600-2801
(831) 600-2801
Mailing address
2250 SOQUEL AVE, SANTA CRUZ, CA 95062-1402
(831) 600-2801
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
02/12/2018
Last updated
06/16/2018
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