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General NPI Number Information
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NPI Number | 1407962624
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Entity Type | Organization
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Legal Business Name | ACTIVE POTENTIAL INCORPORATED
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 7898 OSTROW ST SUITE G
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City | SAN DIEGO
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State | CA
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Zip | 92111-3640
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Country | US
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Telephone | 858-292-4128
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Fax | 858-292-4833
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Provider Business Mailing Address
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Address Line | 7898 OSTROW ST SUITE G
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City | SAN DIEGO
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State | CA
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Zip | 92111-3640
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Country | US
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Telephone | 858-292-4128
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Fax | 858-292-4833
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | MS. ANNA K POLLARD
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Credential |
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Telephone | 858-292-4128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 45651
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License Number State | CA
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