| Innovative Neurology | |
|
24671 Monroe Ave # C102 Murrieta CA 92562-9589 | |
| (951) 797-4446 | |
| (833) 989-2495 |
| Full Name | Innovative Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 24671 Monroe Ave # C102, Murrieta, California |
| Authorized Official Name and Position | Janice Raquel Fuentes (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6193061127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Neurology 24671 Monroe Ave # C102 Murrieta CA 92562-9589 Ph: (951) 797-4446 | Innovative Neurology 24671 Monroe Ave # C102 Murrieta CA 92562-9589 Ph: (951) 797-4446 |
| NPI Number | 1104434075 |
|---|---|
| Provider Enumeration Date | 07/16/2020 |
| Last Update Date | 02/15/2021 |
| Certification Date | 02/15/2021 |
| Medicare PECOS PAC ID | 4981020765 |
|---|---|
| Medicare Enrollment ID | O20200812000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104434075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Janice Raquel Fuentes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053637918 PECOS PAC ID: 9830327063 Enrollment ID: I20140116000494 |
| Provider Name | Ricardo Librado Olivo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154647014 PECOS PAC ID: 0648496224 Enrollment ID: I20140717002025 |
| Provider Name | Silvana Dulanto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831975069 PECOS PAC ID: 0446600654 Enrollment ID: I20240102000356 |
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