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General NPI Number Information
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NPI Number | 1487928123
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Entity Type | Organization
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Legal Business Name | INNOVATIVE FEDERAL OPERATIONS GROUP
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 640 E VISTA WAY SUITE B
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City | VISTA
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State | CA
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Zip | 92084-5535
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Country | US
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Telephone | 760-536-4144
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Fax | 888-415-8297
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Provider Business Mailing Address
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Address Line | 640 E VISTA WAY SUITE B
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City | VISTA
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State | CA
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Zip | 92084-5535
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Country | US
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Telephone | 760-536-4144
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Fax | 888-415-8297
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Authorized Official
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Title or Position | CEO
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Name | MR. LARRY L WICK
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Credential |
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Telephone | 760-889-9425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | B2009034145
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | FHB101207653
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License Number State | CA
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