1851561054 NPI number — MRS. MICHELLE VON SNYDER NP

Table of content: MRS. MICHELLE VON SNYDER NP (NPI 1851561054)

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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