Organization
INNOVATIVE FEDERAL OPERATIONS GROUP
Active
Other names
IFOG
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY L WICK (CEO)
(760) 889-9425
Entity
Organization
Contact information
Practice address
640 E VISTA WAY, SUITE B, VISTA, CA 92084-5535
(760) 536-4144
(888) 415-8297
Mailing address
640 E VISTA WAY, SUITE B, VISTA, CA 92084-5535
(760) 536-4144
(888) 415-8297
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
FHB101207653
CA
335E00000X
Prosthetic/Orthotic Supplier
B2009034145
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
829402309
DUNS
CA
Enumeration date
02/27/2012
Last updated
02/27/2012
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