Healthcare Provider Details

I. General information

NPI: 1720171259
Provider Name (Legal Business Name): ORRENZO BENALLY SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 PEARSON DR STE 100
PORTERVILLE CA
93257-3333
US

IV. Provider business mailing address

263 PEARSON DR STE 100
PORTERVILLE CA
93257-3333
US

V. Phone/Fax

Practice location:
  • Phone: 559-772-4301
  • Fax: 559-772-4302
Mailing address:
  • Phone: 559-772-4301
  • Fax: 559-772-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC172411
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number6844039-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: