MEDICARE: INNOVATE HEALTH MEDICAL CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1427908110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATE HEALTH MEDICAL CLINIC CORP

Provider Business Mailing Address
First Line	:	4051 NW 43RD ST STE 33
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 NW 43RD ST STE 33
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4579
Country	:	US
Telephone Number	:	786-616-2146
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	NOIRALTIH HERRERA
Credential	:
Telephone Number	:	786-616-2146

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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