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Organization
ACTIVE HEALTH CLINIC LLC
Active
Organization
ACTIVE HEALTH CLINIC LLC
Active
Other names
ACTIVE HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KASSRA MICHAEL KHAZALPOUR MD, MBA (PRESIDENT)
(415) 279-0947
Entity
Organization
Contact information
Practice address
1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
(415) 279-0947
Mailing address
1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
(415) 279-0947
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
01/10/2025
Last updated
01/27/2025
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