Healthcare Provider Details

I. General information

NPI: 1750124772
Provider Name (Legal Business Name): SHRINKRAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 130
RIVERSIDE CA
92506-4266
US

IV. Provider business mailing address

6800 INDIANA AVE STE 130
RIVERSIDE CA
92506-4266
US

V. Phone/Fax

Practice location:
  • Phone: 626-826-6251
  • Fax:
Mailing address:
  • Phone: 626-826-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND CHUNG
Title or Position: OWNER
Credential: LMFT
Phone: 626-826-6251