Provider Demographics
NPI:1790967255
Name:SNOOK, SEAN EDWARD (NAVY IDC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:EDWARD
Last Name:SNOOK
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3985 CUMMINGS RD STE 4
Mailing Address - Street 2:BLDG 116
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-5289
Mailing Address - Country:US
Mailing Address - Phone:619-556-1465
Mailing Address - Fax:619-556-1458
Practice Address - Street 1:3985 CUMMINGS RD STE 4
Practice Address - Street 2:BLDG 116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5289
Practice Address - Country:US
Practice Address - Phone:619-556-1465
Practice Address - Fax:619-556-1458
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman