Active Mobile Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ACTIVE MOBILE MEDICAL GROUP, INC.

Practice address

3450 Wilshire Blvd Ste 1200
Los Angeles, CA 90010-2214

Phone

(213) 465-2643

Fax

(213) 232-4944

NPI assigned

Feb 28, 2022

Organization subpart

No

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

Authorized official

Name

Joanna Balasico, RN

Title

Vice President

Phone

(213) 465-2643

Specialties & licenses 2

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nadia Heidi Blanco, FNP

  • Family Nurse Practitioner
  • Hawthorne, CA
  • NPI 1013585587

  Multi-Specialty

  NPD
• Gemelia Holgado Aguilera, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1972616100
  NPD
• Reynaldo Limpin Makabali, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1598757577
  NPD (past)
• Brent Lee Pennington, M.D.

  • Family Medicine Physician
  • Corpus Christi, TX
  • NPI 1205098753
  NPD (past)

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

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1184370199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 WILSHIRE BLVD STE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101733",
            "telephone_number": "213-465-2643",
            "fax_number": "213-232-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 WILSHIRE BLVD STE 1200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102214",
            "telephone_number": "213-465-2643",
            "fax_number": "213-232-4944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE MOBILE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-28",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "BALASICO",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "213-465-2643",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Active Health Physical Therapy, Inc. (Active Health Physical Therapy)
• Active Life Physical Therapy, Inc. (Active Physical Therapy & Wellness)
• Active Life, LLC
• Active Life, LLC
• Active Medical Equipment & Supplis
• Active Pain Relief Inc
• Acu Chiro Clinic
• Acu Therapy Pain Clinic, Inc
• Acu-Chiro Clinic
• Acucenter of la, Inc

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; 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.