Healthcare Provider Details

I. General information

NPI: 1437636081
Provider Name (Legal Business Name): DANIEL SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 37TH ST
OAKLAND CA
94608-3913
US

IV. Provider business mailing address

251 GEORGIA ST
VALLEJO CA
94590-5905
US

V. Phone/Fax

Practice location:
  • Phone: 415-298-5858
  • Fax:
Mailing address:
  • Phone: 707-558-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: