Healthcare Provider Details

I. General information

NPI: 1841864667
Provider Name (Legal Business Name): ISAAC ANDREW SNYDER BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1889 W REDLANDS BLVD BLDG 9
REDLANDS CA
92373-3119
US

IV. Provider business mailing address

7890 VIA BELFIORE UNIT 4
SAN DIEGO CA
92129-5168
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-5165
  • Fax:
Mailing address:
  • Phone: 858-500-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: