Provider Demographics
NPI:1164293445
Name:INNOVISTA TECH SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVISTA TECH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELRAZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-491-5489
Mailing Address - Street 1:9700 S CENTRAL AVE UNIT 221
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-8398
Mailing Address - Country:US
Mailing Address - Phone:602-491-5489
Mailing Address - Fax:
Practice Address - Street 1:9700 S CENTRAL AVE UNIT 221
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8398
Practice Address - Country:US
Practice Address - Phone:602-491-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage