Healthcare Provider Details

I. General information

NPI: 1871098822
Provider Name (Legal Business Name): KYLIE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY DR
ORANGE CA
92866-1005
US

IV. Provider business mailing address

1401 RANCHO RD
ARCADIA CA
91006-2245
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6758
  • Fax:
Mailing address:
  • Phone: 310-975-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: