Provider Demographics
NPI:1740930684
Name:CRUDEN, BRENDA (CMT, ANMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CRUDEN
Suffix:
Gender:F
Credentials:CMT, ANMT
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 256
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-0256
Mailing Address - Country:US
Mailing Address - Phone:650-808-0887
Mailing Address - Fax:
Practice Address - Street 1:948 DOLORES AVE # D
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6010
Practice Address - Country:US
Practice Address - Phone:650-808-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X, 173C00000X, 174H00000X
CA86998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator