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
16008 KAMANA RD STE 202A, APPLE VALLEY, CA 92307-1376
(760) 515-6311
(760) 410-6187
Mailing address
1577 E CHEVY CHASE DR STE 210, GLENDALE, CA 91206-4741
(818) 495-4610
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0009601
—
CA
Enumeration date
05/07/2019
Last updated
01/24/2023
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