Healthcare Provider Details

I. General information

NPI: 1689155319
Provider Name (Legal Business Name): DARREN LAWRENCE SNYDER RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE # A107
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

10000 N 31ST AVE # A107
PHOENIX AZ
85051-9582
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2388
  • Fax:
Mailing address:
  • Phone: 602-441-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86037883
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: