Basic Information
| Provider Information | |||||||||
| NPI: | 1013645084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENN SNYDERS, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3514 HARWICH DR | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920107065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574081656 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 JAMBOREE RD STE 1200 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499887888 | ||||||||
| FaxNumber: | 9499887889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNYDERS | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7574081656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.