Healthcare Provider Details

I. General information

NPI: 1457708935
Provider Name (Legal Business Name): GLENN CHARLES SNYDERS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JAMBOREE RD STE 1200
NEWPORT BEACH CA
92660-2904
US

IV. Provider business mailing address

3501 JAMBOREE RD STE 1200
NEWPORT BEACH CA
92660-2904
US

V. Phone/Fax

Practice location:
  • Phone: 619-493-2314
  • Fax:
Mailing address:
  • Phone: 619-493-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number177883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: