Healthcare Provider Details

I. General information

NPI: 1285545400
Provider Name (Legal Business Name): FROZEN IN TIME CRYO THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31534 RAILROAD CANYON RD STE H
CANYON LAKE CA
92587-9439
US

IV. Provider business mailing address

31534 RAILROAD CANYON RD STE H
CANYON LAKE CA
92587-9439
US

V. Phone/Fax

Practice location:
  • Phone: 888-348-2796
  • Fax:
Mailing address:
  • Phone: 888-348-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN JACOBSON-ESTELL
Title or Position: PRESIDENT
Credential: BEHAVIOR ANALYST
Phone: 888-348-2796