Healthcare Provider Details

I. General information

NPI: 1245017755
Provider Name (Legal Business Name): KACIE NICOLE SNYDER AC 11485
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HOPE LN
SANTA ANA CA
92705-8206
US

IV. Provider business mailing address

1056 HOPE LN
SANTA ANA CA
92705-8206
US

V. Phone/Fax

Practice location:
  • Phone: 949-872-1935
  • Fax:
Mailing address:
  • Phone: 949-872-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: