Healthcare Provider Details

I. General information

NPI: 1023867835
Provider Name (Legal Business Name): KIRSHAWN S SNYDER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26624 SAFFRON CIR
MORENO VALLEY CA
92555-3834
US

IV. Provider business mailing address

26624 SAFFRON CIR
MORENO VALLEY CA
92555-3834
US

V. Phone/Fax

Practice location:
  • Phone: 951-485-0873
  • Fax:
Mailing address:
  • Phone: 951-485-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: