Organization
ACTIVE HEALTH CLINIC LLC
Active
Other names
ACTIVE HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KASSRA MICHAEL KHAZALPOUR MD, MBA (PRESIDENT)
(415) 279-0947
Entity
Organization
Contact information
Practice address
1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
(415) 279-0947
Mailing address
1948 OCEAN RIDGE CIR, VERO BEACH, FL 32963-2730
(415) 279-0947
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
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
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