1851561054 NPI number — MRS. MICHELLE VON SNYDER NP

Table of content: (NPI 1518482181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851561054 NPI number — MRS. MICHELLE VON SNYDER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
MICHELLE
Provider Middle Name:
VON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851561054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 WEST ARBOR DRIVE
Provider Second Line Business Mailing Address:
MC 8201 UCSD PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-8201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-1891
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31720 TEMECULA PARKWAY
Provider Second Line Business Practice Location Address:
TEMECULA VALLEY CLINIC
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-303-0734
Provider Business Practice Location Address Fax Number:
951-303-8591
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  NP95001845 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: RN072105-AP05406 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1039403 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA165763 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1851561054 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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