Organization Active NPI

Proactivehealthllc

  • Clinic/Center
  • Tustin, CA
National Provider Identifier
1083584023
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROACTIVEHEALTHLLC
Practice address
17601 17TH St Ste 120
Tustin, CA 92780-1946
Phone
(657) 210-4547
NPI assigned
Nov 6, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Authorized official

Name
Manwell Soliman
Title
Ceo
Phone
(562) 658-6766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

17601 17TH St Ste 120
Tustin, CA 92780-1946

Mailing address

17601 17TH St Ste 120
Tustin, CA 92780-1946
Phone (657) 210-4547

National Provider Directory

National Provider Directory

Locations

17601 17th St
Ste 120
Tustin, CA 92780
Phone (657) 210-4547

NPI Registry JSON

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

{
    "created_epoch": "1762387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1083584023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17601 17TH ST STE 120",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801946",
            "telephone_number": "657-210-4547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17601 17TH ST STE 120",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801946",
            "telephone_number": "657-210-4547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVEHEALTHLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "SOLIMAN",
        "authorized_official_first_name": "MANWELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-658-6766"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; 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.