Healthcare Provider Details

I. General information

NPI: 1770625857
Provider Name (Legal Business Name): ACTIVE FEET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 LA JOLLA VILLAGE DR #9026
SAN DIEGO CA
92122-1241
US

IV. Provider business mailing address

550 LOMAS SANTA FE DR SUITE B
SOLANA BEACH CA
92075-1343
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-5057
  • Fax: 858-453-5058
Mailing address:
  • Phone: 858-792-1142
  • Fax: 858-755-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK A REINGOLD
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 858-792-1142