Healthcare Provider Details

I. General information

NPI: 1487748018
Provider Name (Legal Business Name): JOEL MYRON SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 ALVARADO ROAD #120
SAN DIEGO CA
92120
US

IV. Provider business mailing address

6475 ALVARADO ROAD #120
SAN DIEGO CA
92120
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-6133
  • Fax: 619-583-0321
Mailing address:
  • Phone: 619-583-6133
  • Fax: 619-583-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG39469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: