Healthcare Provider Details

I. General information

NPI: 1750160883
Provider Name (Legal Business Name): OLE SNYDER MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

PO BOX 230073
ENCINITAS CA
92023-0073
US

V. Phone/Fax

Practice location:
  • Phone: 760-203-1116
  • Fax: 951-527-5655
Mailing address:
  • Phone: 760-203-1116
  • Fax: 951-527-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OLE SNYDER
Title or Position: OWNER
Credential: MD
Phone: 760-203-1116