# ACTIVE HEALTH CLINIC LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** ACTIVE HEALTH CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417767518
- **Authorized official:** DR. KASSRA MICHAEL KHAZALPOUR MD, MBA (PRESIDENT)
- **Authorized official phone:** (415) 279-0947

## Contact information

- **Practice address:** 1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
- **Practice address phone:** (415) 279-0947
- **Mailing address:** 1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
- **Mailing address phone:** (415) 279-0947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | — | — |
| 174H00000X | Health Educator | — | — | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 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