# ACTIVE LIFE WOUND CLINIC A PROFESSIONAL NURSING CORPORATION

> 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
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801253323
- **Authorized official:** JEFF SOUZA (PRESIDENT)
- **Authorized official phone:** (916) 436-3015

## Contact information

- **Practice address:** 2 SCRIPPS DR STE 202, SACRAMENTO, CA 95825-6207
- **Practice address phone:** (916) 436-3015
- **Mailing address:** PO BOX 661587, SACRAMENTO, CA 95866-1587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/28/2016
- **Last updated:** 04/15/2025