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General NPI Number Information
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NPI Number | 1720645328
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Entity Type | Organization
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Legal Business Name | CREATIVE CHILD AND FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 7049 OHIO RIVER DR
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City | EASTVALE
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State | CA
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Zip | 91752
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Country | US
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Telephone | 310-946-2398
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Fax | 951-479-5169
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Provider Business Mailing Address
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Address Line | 1655 E. 6TH STREET A-4 #102
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City | CORONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 909-548-2959
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Fax | 951-479-5169
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Authorized Official
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Title or Position | CEO
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Name | BARBARA TIMMONS
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Credential |
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Telephone | 310-946-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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