Organization
ACTIVE LIFE WOUND CENTER A PROFESSIONAL MEDICAL CORPORATION
Active
Other names
Active Life Wound Center
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SOUZA (COMPLIANCE MANAGER)
(916) 436-3015
Entity
Organization
Contact information
Practice address
2 SCRIPPS DR STE 202, SACRAMENTO, CA 95825-6207
(916) 436-3015
Mailing address
PO BOX 661587, SACRAMENTO, CA 95866-1587
(916) 436-3015
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/19/2024
Last updated
12/19/2024
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