Active Life, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ACTIVE LIFE, LLC

Practice address

72780 Country Club Dr Ste 300
Rancho Mirage, CA 92270-4150

Phone

(909) 748-0168

Fax

(909) 748-5881

NPI assigned

Jun 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Spencer Arden Doty

Title

President

Phone

(858) 616-7724

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Active Life LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Active Life, LLC

  • Prosthetic/Orthotic Supplier
  • Palmdale, CA
  • NPI 1366953168
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1083284590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 E CHEVY CHASE DR STE 210",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064741",
            "telephone_number": "818-495-4610",
            "fax_number": "818-484-2812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE 300",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704150",
            "telephone_number": "909-748-0168",
            "fax_number": "909-748-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "DOTY",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "ARDEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-616-7724",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XC0009601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Naeem Nidal Abu-Shehab, M.D.
• Roux Abubakar, MD
• Mohammad Salah Izzat Abushehab, MD
• Athziri Aceves-Hernandez
• Yulissa Acosta
• Adam Farzaneh MD PC
• Jenna Adams, FNP-C
• Eldad Adler, M.D
• Advance Desert Sleep Center
• Advanced Acupuncture & Wellness Center

• Prosthetic/Orthotic Supplier in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.