Healthcare Provider Details

I. General information

NPI: 1669333845
Provider Name (Legal Business Name): MALIBU BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16365 PICK PL
RIVERSIDE CA
92504-5638
US

IV. Provider business mailing address

16365 PICK PL
RIVERSIDE CA
92504-5638
US

V. Phone/Fax

Practice location:
  • Phone: 714-887-3816
  • Fax: 209-203-1061
Mailing address:
  • Phone: 714-887-3816
  • Fax: 209-203-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANGELIKA PANOVA BOHANNAN
Title or Position: CEO
Credential: LMFT
Phone: 714-887-3816