Healthcare Provider Details

I. General information

NPI: 1619828902
Provider Name (Legal Business Name): INNOVAMED INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38340 INNOVATION CT # D-403
MURRIETA CA
92563-2621
US

IV. Provider business mailing address

38340 INNOVATION CT # D-403
MURRIETA CA
92563-2621
US

V. Phone/Fax

Practice location:
  • Phone: 951-521-2839
  • Fax:
Mailing address:
  • Phone: 951-521-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMEO REYES LADERO JR.
Title or Position: EXECUTIVE MARKETING
Credential: NP
Phone: 951-521-2839