Basic Information
| Provider Information | |||||||||
| NPI: | 1275557415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | OLE | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1926 VISTA CENTRE | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609015030 | ||||||||
| FaxNumber: | 7607548164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1926 VISTA CTR STE A | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920816056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609407000 | ||||||||
| FaxNumber: | 7609400042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A60938 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A609380 | 05 | CA | MEDICAID |