Healthcare Provider Details

I. General information

NPI: 1013392513
Provider Name (Legal Business Name): EZRA SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2015
Last Update Date: 07/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 IRVING ST STE 200
SAN FRANCISCO CA
94122-1620
US

IV. Provider business mailing address

2339 IRVING ST STE 200
SAN FRANCISCO CA
94122-1620
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-1591
  • Fax: 415-221-3274
Mailing address:
  • Phone: 415-221-1591
  • Fax: 415-221-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: