Provider Demographics
NPI:1437736295
Name:INITIAL INNOVATIVE BLOOD, LLC
Entity type:Organization
Organization Name:INITIAL INNOVATIVE BLOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-209-9009
Mailing Address - Street 1:16481 WATERWAY CIR APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3256
Mailing Address - Country:US
Mailing Address - Phone:714-209-9009
Mailing Address - Fax:714-384-7233
Practice Address - Street 1:16481 WATERWAY CIR APT B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3256
Practice Address - Country:US
Practice Address - Phone:714-209-9009
Practice Address - Fax:714-384-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty