Active Wellness LLC

Primary specialty

Obesity and Weight Management Nutrition Registered DietitianTaxonomy code 133VN1201X

Legal business name

ACTIVE WELLNESS LLC

Practice address

600 California St FL 11
San Francisco, CA 94108-2727

Phone

(415) 377-8595

NPI assigned

Jun 28, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Carey White III

Title

Cfo

Phone

(415) 377-8595

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1593302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593302400000",
    "number": "1114544970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2358",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941262358",
            "telephone_number": "415-377-8595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CALIFORNIA ST FL 11",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941082727",
            "telephone_number": "415-377-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-28",
        "last_updated": "2020-06-28",
        "certification_date": "2020-06-28",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CAREY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "415-377-8595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obesity and Weight Management Nutrition Registered Dietitian in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Obesity and Weight Management Nutrition Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2020; 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.