Provider Demographics
NPI:1649959818
Name:INNOVA MIND AND BODY
Entity type:Organization
Organization Name:INNOVA MIND AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL-ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-250-3746
Mailing Address - Street 1:16712 HUFFMEISTER RD STE 400A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8695
Mailing Address - Country:US
Mailing Address - Phone:832-850-3110
Mailing Address - Fax:832-850-3112
Practice Address - Street 1:16712 HUFFMEISTER RD STE 400A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8695
Practice Address - Country:US
Practice Address - Phone:832-850-3110
Practice Address - Fax:832-850-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty