Healthcare Provider Details

I. General information

NPI: 1417800129
Provider Name (Legal Business Name): ACTIVA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WATERFALL DR STE C
ELKHART IN
46516-3683
US

IV. Provider business mailing address

234 WATERFALL DR STE C
ELKHART IN
46516-3683
US

V. Phone/Fax

Practice location:
  • Phone: 574-307-5502
  • Fax: 866-598-4540
Mailing address:
  • Phone: 574-307-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TALHIA YAJAIRA JUAREZ-AGUILAR
Title or Position: OWNER/CEO
Credential: DNP
Phone: 574-307-5502