Healthcare Provider Details

I. General information

NPI: 1215582507
Provider Name (Legal Business Name): LEAH MARIE SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 REED AVE APT 213
SAN DIEGO CA
92109-3960
US

IV. Provider business mailing address

808 REED AVE APT 213
SAN DIEGO CA
92109-3960
US

V. Phone/Fax

Practice location:
  • Phone: 412-559-2011
  • Fax:
Mailing address:
  • Phone: 412-559-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060761
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: