Healthcare Provider Details

I. General information

NPI: 1821250077
Provider Name (Legal Business Name): JONATHAN MICHAEL SNIPES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31569 CANYON ESTATES DR STE 105
LAKE ELSINORE CA
92532-0470
US

IV. Provider business mailing address

SNIPES MEDICAL SERVICES #1053 78 FOLLY ROAD STE B9
CHARLESTON SC
29407-6522
US

V. Phone/Fax

Practice location:
  • Phone: 951-852-4357
  • Fax:
Mailing address:
  • Phone: 800-835-2362
  • Fax: 864-877-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number333457
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42.0016474
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2020-03650
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD482677
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC182596
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30931
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number325928
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number101271031
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36.154753
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT9032
License Number StateTX
# 11
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number213384
License Number StateAK
# 12
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0096307
License Number StateMD
# 13
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME158707
License Number StateFL
# 14
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number66079
License Number StateGA
# 15
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41991
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: