Healthcare Provider Details

I. General information

NPI: 1053244178
Provider Name (Legal Business Name): ACTIVCARE MED GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 CARNELIAN ST STE 112
RANCHO CUCAMONGA CA
91730-1156
US

IV. Provider business mailing address

7365 CARNELIAN ST STE 112
RANCHO CUCAMONGA CA
91730-1156
US

V. Phone/Fax

Practice location:
  • Phone: 951-344-5023
  • Fax: 951-346-1281
Mailing address:
  • Phone: 951-344-5023
  • Fax: 951-346-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PRODE PASCUAL
Title or Position: OWNER
Credential: MD
Phone: 951-344-5023