Provider Demographics
NPI:1942388962
Name:SNYDER, MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
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 1:3400 LOMITA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4900
Mailing Address - Country:US
Mailing Address - Phone:310-540-0965
Mailing Address - Fax:310-540-6721
Practice Address - Street 1:3400 LOMITA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4900
Practice Address - Country:US
Practice Address - Phone:310-540-0965
Practice Address - Fax:310-540-6721
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG242050Medicaid
CAOOG242050Medicaid
CAWG24205EMedicare ID - Type Unspecified
CAA42197Medicare UPIN
CAW14194BMedicare ID - Type Unspecified