Organization
INNOVATIVE NEUROLOGY, INC.
Active
Other names
Innovative Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE RAQUEL FUENTES MD (AUTHORIZED OFFICIAL)
(619) 306-1127
Entity
Organization
Contact information
Practice address
24671 MONROE AVE # C102, MURRIETA, CA 92562-9589
(951) 797-4446
(833) 989-2495
Mailing address
24671 MONROE AVE # C102, MURRIETA, CA 92562-9589
(951) 797-4446
(833) 989-2495
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Enumeration date
07/16/2020
Last updated
02/15/2021
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