Healthcare Provider Details

I. General information

NPI: 1205030665
Provider Name (Legal Business Name): SEAN JOSEPH SNODGRESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PUEBLO AT BATH ST
SANTA BARBARA CA
93102-0689
US

IV. Provider business mailing address

PO BOX 4219
ORANGE CA
92863-4219
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-7279
  • Fax: 805-569-8279
Mailing address:
  • Phone: 800-984-7070
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2005-00658
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: