Provider Demographics
NPI:1083589634
Name:INNOVATIVE SOLUTIONS X LLC
Entity type:Organization
Organization Name:INNOVATIVE SOLUTIONS X LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-263-2207
Mailing Address - Street 1:8480 TYCO RD STE D
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR
Practice Address - Street 2:STE 5003
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132
Practice Address - Country:US
Practice Address - Phone:571-263-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)