Provider Demographics
NPI:1851842124
Name:SNYDER, SUZANNE
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUZI
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:62 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9654
Mailing Address - Country:US
Mailing Address - Phone:510-859-5101
Mailing Address - Fax:
Practice Address - Street 1:62 SUNSET DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-9654
Practice Address - Country:US
Practice Address - Phone:510-859-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10282133NN1002X
CAL.AC. 10282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education