Provider Demographics
NPI:1275557415
Name:SNYDER, OLE WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLE
Middle Name:WARREN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 VISTA CENTRE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-901-5030
Mailing Address - Fax:760-754-8164
Practice Address - Street 1:1926 VISTA CTR STE A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6056
Practice Address - Country:US
Practice Address - Phone:760-940-7000
Practice Address - Fax:760-940-0042
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A609380Medicaid
CAG88243Medicare UPIN
CAWA69038AMedicare ID - Type Unspecified