Provider Demographics
NPI:1215302393
Name:INNOVATION SURGERY INC.
Entity type:Organization
Organization Name:INNOVATION SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-701-6606
Mailing Address - Street 1:19671 BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:949-701-6606
Mailing Address - Fax:949-681-8144
Practice Address - Street 1:50 DEER TRAK
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8812
Practice Address - Country:US
Practice Address - Phone:949-701-6606
Practice Address - Fax:949-681-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty