Basic Information
| Provider Information | |||||||||
| NPI: | 1871174748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNIDER | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | FOSTER | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4175 WABASH AVE UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921042140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109226367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1738 S TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920545309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604392800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2021 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95023071 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163WP0808X | 95119190 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.