Provider Demographics
NPI:1326668823
Name:INNOVATIVE INTEGRATED HEALTH INC
Entity Type:Organization
Organization Name:INNOVATIVE INTEGRATED HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-228-5577
Mailing Address - Street 1:1200 NEWPORT CENTER DR STE 230
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0933
Mailing Address - Country:US
Mailing Address - Phone:949-228-5577
Mailing Address - Fax:
Practice Address - Street 1:2042 KERN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2008
Practice Address - Country:US
Practice Address - Phone:949-228-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization