# INNOVI HEALTHCARE INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INNOVI HEALTHCARE INC.
- **Other names:** Innovi Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1528689965
- **Legal business name:** INNOVI HEALTHCARE INC.
- **Authorized official:** DR. MARIAM S HASAN MD (CEO)
- **Authorized official phone:** (408) 564-3492

## Contact information

- **Practice address:** 11220 AMBERDALE DR, TUSTIN, CA 92782-4329
- **Practice address phone:** (949) 336-1875
- **Practice address fax:** (844) 946-0854
- **Mailing address:** 11220 AMBERDALE DR, TUSTIN, CA 92782-4329
- **Mailing address phone:** (949) 336-1875
- **Mailing address fax:** (844) 946-0854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/27/2020
- **Last updated:** 04/14/2026