Provider Demographics
NPI:1518463033
Name:SNOWDEN, PAMELA D
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2863
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0054
Mailing Address - Country:US
Mailing Address - Phone:760-217-7725
Mailing Address - Fax:
Practice Address - Street 1:13090 NAVAJO RD APT 2
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-9624
Practice Address - Country:US
Practice Address - Phone:442-292-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
91490538AOtherMOLINA HEATHCARE