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General NPI Number Information
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NPI Number | 1861348351
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Entity Type | Organization
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Legal Business Name | CRESTLINE MEDICAL GROUP PC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 325 S 1ST ST STE 200
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City | SAN JOSE
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State | CA
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Zip | 95113-2835
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Country | US
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Telephone | 415-839-7564
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Fax |
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Provider Business Mailing Address
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Address Line | 325 S 1ST ST STE 200
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City | SAN JOSE
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State | CA
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Zip | 95113-2835
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Country | US
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Telephone | 415-839-7564
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN SNIPES
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Credential | MD
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Telephone | 213-827-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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