MEDICARE: ALIX SNODGRASS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1255175618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIX SNODGRASS

Provider Business Mailing Address
First Line	:	25590 PROSPECT AVE APT 55A
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3159
Country	:	US
Telephone Number	:	909-835-0151
Fax Number	:

Provider Business Practice Location Address
First Line	:	11374 MOUNTAIN VIEW AVE STE D
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3815
Country	:	US
Telephone Number	:	909-558-6832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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