Provider Demographics
NPI:1992501514
Name:INNOVA HEALTH CLINIC LLC
Entity type:Organization
Organization Name:INNOVA HEALTH CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ACEVEDO CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-458-6514
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0303
Mailing Address - Country:US
Mailing Address - Phone:787-458-6514
Mailing Address - Fax:
Practice Address - Street 1:CARR. 110 KM 10.7
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-458-6514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty