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General NPI Number Information
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NPI Number | 1124413620
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Entity Type | Organization
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Legal Business Name | ATIVA LLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 18022 COWAN STE 215
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City | IRVINE
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State | CA
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Zip | 92614-6849
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Country | US
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Telephone | 949-225-2188
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Fax | 949-225-2187
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Provider Business Mailing Address
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Address Line | 18022 COWAN STE 215
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City | IRVINE
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State | CA
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Zip | 92614-6849
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Country | US
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Telephone | 949-225-2188
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Fax | 949-225-2187
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MARVIN PAN
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Credential |
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Telephone | 949-225-2188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | IN PROCESS
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License Number State | CA
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