Provider Demographics
NPI:1073639852
Name:INNOVA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:INNOVA MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AURA
Authorized Official - Middle Name:GRISELLE
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-371-7477
Mailing Address - Street 1:28 W FLAGLER ST
Mailing Address - Street 2:550
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1806
Mailing Address - Country:US
Mailing Address - Phone:305-371-7477
Mailing Address - Fax:305-371-1655
Practice Address - Street 1:28 W FLAGLER ST
Practice Address - Street 2:550
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1806
Practice Address - Country:US
Practice Address - Phone:305-371-7477
Practice Address - Fax:305-371-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL602900-3208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty