ACTIVE LIFE, INC. (NPI# 1952609661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952609661 |
| Entity Type | Organization |
| Organization Name | ACTIVE LIFE, INC. |
| Practice Address |
7910 Frost St Ste 320 San Diego CA 92123 |
| Mailing Address |
1577 E Chevy Chase Dr Suite 210 Glendale CA 91206-4147 |
| Practice Telephone | 6194886196 |
| Practice Fax Number | 6192727615 |
| Mailing Telephone | 8184954610 |
| Mailing Fax Number | 8184842812 |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2018-08-02 |
| Authorized Official Name | SPENCER DOTY (PRESIDENT) |
| Authorized Official Telephone | 8185228781 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDI-CAL | XC0009601 | 01 |
| CA | XC0009601 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154986750 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 3407 W 6th St Ste 815, Los Angeles, CA 90020-2555 | 2019-05-08 |
| 1609342914 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1980 Orange Tree Ln Ste 230, Redlands, CA 92374-4559 | 2018-10-15 |
| 1063902708 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1710 Plum Ln Ste C, Redlands, CA 92374-0100 | 2018-05-17 |
| 1568961977 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 855 N Lark Ellen Ave Ste A, West Covina, CA 91791-1099 | 2018-02-12 |
| 1669988176 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 29645 Rancho California Rd Ste 213, Temecula, CA 92591-5285 | 2017-12-19 |
| 1497264733 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 23141 Moulton Pkwy Ste 109, Laguna Hills, CA 92653-1241 | 2017-09-28 |
| 1952765711 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1700 E Cesar E Chavez Ave Ste 3750, Los Angeles, CA 90033 | 2016-04-07 |
| 1073162244 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 3300 E South St Ste 305, Lakewood, CA 90805-4595 | 2019-09-10 |
| 1942865605 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 16008 Kamana Rd, Apple Valley, CA 92307-1376 | 2019-05-07 |
| 1619475894 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 20911 Earl St Ste 290, Torrance, CA 90503-4354 | 2018-01-23 |
| Street Address |
7910 FROST ST STE 320 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992281489 | Madonna Ibrahim | Orthotist | 7910 Frost St Ste 320, San Diego, CA 92123 | 2018-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154815025 | Alcam Medical Inc. | Prosthetic/Orthotic Supplier | 6244 El Cajon Blvd Ste 12, San Diego, CA 92115-3918 | 2018-06-14 |
| 1215484720 | Telehealth Clinical Services | Prosthetic/Orthotic Supplier | 2667 Camino Del Rio South #207, San Diego, CA 92108-3765 | 2016-09-01 |
| 1770931438 | A Greater Hope | Prosthetic/Orthotic Supplier | 2515 Camino Del Rio S Ste 242a, San Diego, CA 92108-3715 | 2016-06-02 |
| 1649638701 | Norell Prosthetics Orthotics Inc. | Prosthetic/Orthotic Supplier | 5466 Complex St Ste 207, San Diego, CA 92123-1124 | 2016-02-04 |
| 1194132795 | Annadon, Inc. | Prosthetic/Orthotic Supplier | 4079 Governor Dr, Suite 700, San Diego, CA 92122-2522 | 2014-07-15 |
| 1487945739 | Ruthiva LLC | Prosthetic/Orthotic Supplier | 10601 Tierrasanta Blvd, Ste G-188, San Diego, CA 92124-2616 | 2011-04-20 |
| 1518147289 | Precision Medical, Inc. | Prosthetic/Orthotic Supplier | 4424 44th St, Suite 315, San Diego, CA 92115-4300 | 2007-11-09 |
| 1508911173 | J & J Artificial Limb & Brace LLC | Prosthetic/Orthotic Supplier | 11411 W Bernardo Ct., San Diego, CA 92127 | 2007-01-24 |
| 1508876442 | Carlos Valenzuela | Prosthetic/Orthotic Supplier | 4224 Ohio St, San Diego, CA 92104-1320 | 2006-08-09 |
| 1114943578 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 6997 Friars Rd, San Diego, CA 92108-1100 | 2006-07-15 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.