Healthcare Provider Details

I. General information

NPI: 1073162228
Provider Name (Legal Business Name): SANDRA RENE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BELLE TER
BAKERSFIELD CA
93307-3871
US

IV. Provider business mailing address

2005 RIDGE RD
BAKERSFIELD CA
93305-4123
US

V. Phone/Fax

Practice location:
  • Phone: 661-336-6697
  • Fax:
Mailing address:
  • Phone: 661-868-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: