Organization
ACTIVE ADULTS PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESTREANDA FULFORD (CEO)
(619) 908-2643
Entity
Organization
Contact information
Practice address
7940 SILVERTON AVE STE 204, SAN DIEGO, CA 92126-6341
(619) 908-2643
Mailing address
11475 HADAR DR, SAN DIEGO, CA 92126-1361
(619) 908-2643
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/05/2025
Last updated
11/05/2025
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