Provider Demographics
NPI:1245527720
Name:PRUES, ERIN (CMT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PRUES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20045 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20045 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2353
Practice Address - Country:US
Practice Address - Phone:650-275-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19424171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor