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General NPI Number Information
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NPI Number | 1255175618
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Entity Type | Individual
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Provider Name | ALIX SNODGRASS
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Gender |
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 11374 MOUNTAIN VIEW AVE STE D
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City | LOMA LINDA
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State | CA
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Zip | 92354-3815
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Country | US
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Telephone | 909-558-6832
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Fax |
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Provider Business Mailing Address
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Address Line | 25590 PROSPECT AVE APT 55A
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City | LOMA LINDA
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State | CA
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Zip | 92354-3159
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Country | US
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Telephone | 909-835-0151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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