Provider Demographics
NPI:1275153389
Name:INNOVI HEALTHCARE INC.
Entity Type:Organization
Organization Name:INNOVI HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-336-1875
Mailing Address - Street 1:11220 AMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-4329
Mailing Address - Country:US
Mailing Address - Phone:949-336-1875
Mailing Address - Fax:844-946-0854
Practice Address - Street 1:11220 AMBERDALE DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-4329
Practice Address - Country:US
Practice Address - Phone:949-336-1875
Practice Address - Fax:844-946-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty