Organization
ACTIVECARERX WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IDRIS CLARK (PARTNER)
(949) 757-4651
Entity
Organization
Contact information
Practice address
1301 DOVE ST, SUITE 800, NEWPORT BEACH, CA 92660-2412
(949) 757-0571
(949) 757-1056
Mailing address
1301 DOVE ST, SUITE 800, NEWPORT BEACH, CA 92660-2412
(949) 757-0571
(949) 757-1056
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/17/2013
Last updated
10/17/2013
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