Healthcare Provider Details

I. General information

NPI: 1932930120
Provider Name (Legal Business Name): CALIFORNIA HEALING HORIZONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 240
RIVERSIDE CA
92507-7403
US

IV. Provider business mailing address

967 KENDALL DR STE A-515
SAN BERNARDINO CA
92407-4306
US

V. Phone/Fax

Practice location:
  • Phone: 909-856-5904
  • Fax:
Mailing address:
  • Phone: 909-856-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. INA CREEKBAUM
Title or Position: CEO
Credential:
Phone: 909-856-5904