Healthcare Provider Details

I. General information

NPI: 1922108752
Provider Name (Legal Business Name): JOHN ROBINSON SNIBBE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 MORENO AVE
LOS ANGELES CA
90049-4832
US

IV. Provider business mailing address

550 S VERMONT AVE (10TH FLOOR)
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 310-393-2494
  • Fax:
Mailing address:
  • Phone: 213-639-6383
  • Fax: 213-351-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY3996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: