Provider Demographics
NPI:1225332794
Name:SNOW, TODD L
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:L
Last Name:SNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7866
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-7866
Mailing Address - Country:US
Mailing Address - Phone:909-957-2098
Mailing Address - Fax:
Practice Address - Street 1:876 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4166
Practice Address - Country:US
Practice Address - Phone:909-957-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225332794Medicaid
GA1225332794Medicaid
GA1225332794Medicaid
CA1225332794Medicaid