Healthcare Provider Details

I. General information

NPI: 1851561054
Provider Name (Legal Business Name): MICHELLE VON SNYDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31720 TEMECULA PARKWAY TEMECULA VALLEY CLINIC
TEMECULA CA
92592
US

IV. Provider business mailing address

200 WEST ARBOR DRIVE MC 8201 UCSD PROVIDER ENROLLMENT
SAN DIEGO CA
92103-8201
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-0734
  • Fax: 951-303-8591
Mailing address:
  • Phone: 619-543-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95001845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN072105-AP05406
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: