Healthcare Provider Details

I. General information

NPI: 1023448750
Provider Name (Legal Business Name): MATTHEW SNARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 N SUNRISE AVE STE 250
ROSEVILLE CA
95661-3097
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-862-1140
  • Fax: 916-862-1145
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: