Healthcare Provider Details

I. General information

NPI: 1972949998
Provider Name (Legal Business Name): JONATHAN MARK SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

2188 S 1800 E
SALT LAKE CITY UT
84106-4172
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3501
  • Fax: 310-782-1763
Mailing address:
  • Phone: 510-825-1095
  • Fax: 310-782-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11728219-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: