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General NPI Number Information
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NPI Number | 1902150709
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Entity Type | Organization
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Legal Business Name | INNOVATIVE RESEARCH CONSULTING LLC
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 6850 LINCOLN AVE SUITE 105
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City | BUENA PARK
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State | CA
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Zip | 90620-4178
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Country | US
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Telephone | 714-827-1899
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Fax | 714-827-1999
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Provider Business Mailing Address
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Address Line | 6850 LINCOLN AVE SUITE 105
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City | BUENA PARK
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State | CA
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Zip | 90620-4178
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Country | US
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Telephone | 714-827-1899
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Fax | 714-827-1999
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KAREN HYBRIDGE
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Credential | BA/BSN
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Telephone | 714-827-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | C39123
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License Number State | CA
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