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General NPI Number Information
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NPI Number | 1265107569
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Entity Type | Organization
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Legal Business Name | CREATIVE MINDS NETWORKING
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 6809 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506
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Country | US
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Telephone | 951-500-3574
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Fax |
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Provider Business Mailing Address
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Address Line | 17460 KRAMERIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-6129
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Country | US
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Telephone | 951-205-1318
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSANA HEROLD
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Credential |
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Telephone | 951-500-3574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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