Provider Demographics
NPI:1902150709
Name:INNOVATIVE RESEARCH CONSULTING LLC
Entity Type:Organization
Organization Name:INNOVATIVE RESEARCH CONSULTING LLC
Other - Org Name:SOUTHBAY PHARMA RESEARCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:BA/BSN
Authorized Official - Phone:714-827-1899
Mailing Address - Street 1:6850 LINCOLN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4178
Mailing Address - Country:US
Mailing Address - Phone:714-827-1899
Mailing Address - Fax:714-827-1999
Practice Address - Street 1:6850 LINCOLN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4178
Practice Address - Country:US
Practice Address - Phone:714-827-1899
Practice Address - Fax:714-827-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center