Provider Demographics
NPI:1881016780
Name:CRUTTENDEN, KAILA (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:CRUTTENDEN
Suffix:
Gender:F
Credentials:LAC, DIPL OM
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 4
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-0004
Mailing Address - Country:US
Mailing Address - Phone:530-906-0150
Mailing Address - Fax:
Practice Address - Street 1:10049 MARTIS VALLEY RD
Practice Address - Street 2:UNIT E
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0543
Practice Address - Country:US
Practice Address - Phone:530-906-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist