Organization
ACTIVE LIFE MEDICAL MANAGEMENT
Active
Other names
Active Life Medical
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SOUZA (PRESIDENT)
(888) 525-0255
Entity
Organization
Contact information
Practice address
1018 LIVE OAK BLVD., SUITE K, YUBA CITY, CA 95991
(888) 525-0255
(888) 525-0255
Mailing address
PO BOX 586, YUBA CITY, CA 95992-0586
(888) 525-0255
(888) 525-0255
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003378
VA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1526243
UMWA
—
05
—
1962415661
—
VA
01
—
262513
BCBS
VA
Enumeration date
08/14/2006
Last updated
05/13/2015
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