Healthcare Provider Details

I. General information

NPI: 1780606921
Provider Name (Legal Business Name): RENEE SNELLING GILPEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE ZOE SNELLING MD

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S FAIRMONT AVENUE
LODI CA
95240-5118
US

IV. Provider business mailing address

P.O. BOX 788 5000 HOPYARD ROAD SUITE 100
PLEASANTON CA
94566
US

V. Phone/Fax

Practice location:
  • Phone: 800-617-7717
  • Fax: 925-924-0506
Mailing address:
  • Phone: 925-924-1600
  • Fax: 925-924-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number213931
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA75939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: