| NPI | 1396553616 |
|---|---|
| Other Name | ACTIVE LIFE WOUND CENTER |
| Entity Type | Organization |
| Authorized Contact | JEFFREY SOUZA Compliance Manager 916-436-3015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 207N00000X Dermatology | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2024-12-19 |