Healthcare Provider Details

I. General information

NPI: 1780197590
Provider Name (Legal Business Name): JONATHAN PATRICK SNAPP ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 LYNOAK DR
CLAREMONT CA
91711-3223
US

IV. Provider business mailing address

1526 LYNOAK DR
CLAREMONT CA
91711-3223
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-2787
  • Fax:
Mailing address:
  • Phone: 909-706-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000030333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: