Provider Demographics
NPI:1710694666
Name:INNOVATIVE HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:RODRIGUEZ DE LISENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, MPH
Authorized Official - Phone:707-205-5572
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-0183
Mailing Address - Country:US
Mailing Address - Phone:707-205-5572
Mailing Address - Fax:
Practice Address - Street 1:180 OLIVE BRANCH CT
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2108
Practice Address - Country:US
Practice Address - Phone:707-205-5572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered Meals
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch