Provider Demographics
NPI:1295460319
Name:SNYDER, MICHELLE R (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23310 BARONA MESA RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4346
Mailing Address - Country:US
Mailing Address - Phone:760-803-8408
Mailing Address - Fax:
Practice Address - Street 1:23310 BARONA MESA RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4346
Practice Address - Country:US
Practice Address - Phone:760-803-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA852225133V00000X
L-29323174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN