Healthcare Provider Details

I. General information

NPI: 1174698484
Provider Name (Legal Business Name): MARK GREGG SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 MEDICAL CENTER DRIVE SUITE 400
WEST HILLS CA
91307-1963
US

IV. Provider business mailing address

7345 MEDICAL CENTER DRIVE SUITE 400
WEST HILLS CA
91307-1963
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-0460
  • Fax: 818-883-2993
Mailing address:
  • Phone: 818-883-0460
  • Fax: 818-883-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG67520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: