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
1700 E CESAR E CHAVEZ AVE STE 3750, LOS ANGELES, CA 90033
(323) 352-8319
(323) 425-8392
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XC0009601
MEDI CAL
CA
Enumeration date
04/07/2016
Last updated
01/24/2023
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