1205452794 NPI number — INNOVATIVE HEALTHCARE CONSULTANTS

Table of content: (NPI 1205452794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205452794 NPI number — INNOVATIVE HEALTHCARE CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE HEALTHCARE CONSULTANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205452794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 S MAIN AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLBROOK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92028-3352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-731-1334
Provider Business Mailing Address Fax Number:
833-790-2628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
746 S MAIN AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLBROOK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92028-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-731-1334
Provider Business Practice Location Address Fax Number:
833-790-2628
Provider Enumeration Date:
06/19/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIJH-FAUTIER
Authorized Official First Name:
NITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND CEO
Authorized Official Telephone Number:
650-804-6268

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 374700177 . This is a "HOME CARE ORGANIZATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".