Healthcare Provider Details

I. General information

NPI: 1144168774
Provider Name (Legal Business Name): NATALIA IGOREVNA CHUDAKOVA CAMTC 8970
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALYA CHUDAKOVA CAMTC 8970

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BALSAM ST
RIDGECREST CA
93555-3822
US

IV. Provider business mailing address

332 CISCO ST APT A
RIDGECREST CA
93555-5794
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-2367
  • Fax:
Mailing address:
  • Phone: 760-335-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: