Provider Demographics
NPI:1851561054
Name:SNYDER, MICHELLE VON (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:VON
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MC 8201 UCSD PROVIDER ENROLLMENT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8201
Mailing Address - Country:US
Mailing Address - Phone:619-543-1891
Mailing Address - Fax:
Practice Address - Street 1:31720 TEMECULA PARKWAY
Practice Address - Street 2:TEMECULA VALLEY CLINIC
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-0734
Practice Address - Fax:951-303-8591
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001845363LA2200X
LARN072105-AP05406363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039403Medicaid
CACA165763OtherMEDICARE PTAN
CA1851561054Medicaid
CACA165763OtherMEDICARE PTAN