Organization
ACTIVE LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SPENCER ARDEN DOTY (PRESIDENT)
(858) 616-7724
Entity
Organization
Contact information
Practice address
72780 COUNTRY CLUB DR STE 300, RANCHO MIRAGE, CA 92270-4150
(909) 748-0168
(909) 748-5881
Mailing address
1577 E CHEVY CHASE DR STE 210, GLENDALE, CA 91206-4741
(818) 495-4610
(818) 484-2812
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0009601
—
CA
Enumeration date
06/28/2021
Last updated
06/28/2021
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