Provider Demographics
NPI:1245017755
Name:SNYDER, KACIE NICOLE (AC 11485)
Entity type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:NICOLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:AC 11485
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8206
Mailing Address - Country:US
Mailing Address - Phone:949-872-1935
Mailing Address - Fax:
Practice Address - Street 1:1056 HOPE LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8206
Practice Address - Country:US
Practice Address - Phone:949-872-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist