Organization
ACTIVE LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PALLAVI CHINTAPALLI NEMANI (COMPLIANCE OFFICER)
(512) 552-6311
Entity
Organization
Contact information
Practice address
18433 ROSCOE BLVD STE 108, NORTHRIDGE, CA 91325-4131
(818) 835-9441
(818) 539-7962
Mailing address
1577 E CHEVY CHASE DR STE 210, GLENDALE, CA 91206-4741
(818) 495-4610
(818) 484-2812
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0009601
—
CA
Enumeration date
05/26/2006
Last updated
01/24/2023
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