Healthcare Provider Details

I. General information

NPI: 1447516513
Provider Name (Legal Business Name): JOSHUA SNODGRASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SPRING ST STE 1
LONG BEACH CA
90806-1625
US

IV. Provider business mailing address

450 E SPRING ST STE 1
LONG BEACH CA
90806-1625
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA134460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: