Healthcare Provider Details

I. General information

NPI: 1013825264
Provider Name (Legal Business Name): SAMANTHA RUDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 ALABAMA AVE UNIT 310
CANOGA PARK CA
91303-2723
US

IV. Provider business mailing address

6825 ALABAMA AVE UNIT 310
CANOGA PARK CA
91303-2723
US

V. Phone/Fax

Practice location:
  • Phone: 818-331-2129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number39141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: