Provider Demographics
NPI:1255465936
Name:RUCKSTUHL, BRENDA M (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:RUCKSTUHL
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:HADJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:448 SYRINGA ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1637
Mailing Address - Country:US
Mailing Address - Phone:805-905-9238
Mailing Address - Fax:805-493-8217
Practice Address - Street 1:2660 TOWNSGATE RD
Practice Address - Street 2:STE 780
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2714
Practice Address - Country:US
Practice Address - Phone:805-905-9238
Practice Address - Fax:805-493-8217
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered