Innovative Neurology, Inc.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

INNOVATIVE NEUROLOGY, INC.

Practice address

24671 Monroe Ave # C102
Murrieta, CA 92562-9589

Phone

(951) 797-4446

Fax

(833) 989-2495

NPI assigned

Jul 16, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice Raquel Fuentes, MDNPI 1053637918

Title

Authorized Official

Phone

(619) 306-1127

Specialties & licenses 1

Addresses

Other names 1

• Innovative Neurology Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22624/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Janice Raquel Fuentes, MD

  • Neurology Physician
  • Murrieta, CA
  • NPI 1053637918
  Medicare reassignment NPD Authorized official
• Silvana Dulanto, FNP

  • Family Nurse Practitioner
  • Murrieta, CA
  • NPI 1831975069
  Medicare reassignment NPD
• Ricardo Librado Olivo, M.D.

  • Neurology Physician
  • Murrieta, CA
  • NPI 1154647014
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1104434075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24671 MONROE AVE # C102",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629589",
            "telephone_number": "951-797-4446",
            "fax_number": "833-989-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24671 MONROE AVE # C102",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629589",
            "telephone_number": "951-797-4446",
            "fax_number": "833-989-2495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38860 Sky Canyon Dr Bldg A",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925632518",
            "country_code": "US",
            "telephone_number": "442-777-5920",
            "fax_number": "951-466-2744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE NEUROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "RAQUEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "619-306-1127",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Neurology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Innovative Neurology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Neurology Physician in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.