Organization
ACTIVE LIFE WOUND CLINIC A PROFESSIONAL NURSING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF SOUZA (PRESIDENT)
(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
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/28/2016
Last updated
04/15/2025
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