Provider Demographics
NPI:1669735247
Name:SNOWDON, DANIEL ROBERT
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROBERT
Last Name:SNOWDON
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 1:5072 SUBLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4059
Mailing Address - Country:US
Mailing Address - Phone:702-449-0216
Mailing Address - Fax:702-629-4834
Practice Address - Street 1:3550 W CHEYENNE AVE STE 130
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8252
Practice Address - Country:US
Practice Address - Phone:702-570-5200
Practice Address - Fax:702-570-5201
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health