Activecarerx Holdings, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ACTIVECARERX HOLDINGS, LLC

Practice address

1301 Dove St
Suite 800
Newport Beach, CA 92660-2412

Phone

(949) 757-0576

Fax

(949) 757-1056

NPI assigned

Oct 24, 2013

Organization subpart

No

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

Authorized official

Name

Idris Clark

Title

Managing Partner

Phone

(949) 757-0576

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1194153395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 DOVE ST",
            "address_2": "SUITE 800",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602412",
            "telephone_number": "949-757-0576",
            "fax_number": "949-757-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 DOVE ST",
            "address_2": "SUITE 800",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602412",
            "telephone_number": "949-757-0576",
            "fax_number": "949-757-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVECARERX HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "IDRIS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "949-757-0576"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Geree Aceves, LAC
• Boris Ackerman, M.D.
• Makenzy Juliet Acklin
• Daisy Acosta
• Tahlia Acosta
• Activecarerx Wellness, LLC
• Kristi Acuna, BSNU
• Adam Blatt MD Inc
• Adam M. Rotunda, M.D., a Professional Corporation
• Michael Adams, LAC

• All providers in Newport Beach, CA
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; 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.