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General NPI Number Information
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NPI Number | 1417800129
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Entity Type | Organization
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Legal Business Name | ACTIVA HEALTH
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 234 WATERFALL DR STE C
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City | ELKHART
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State | IN
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Zip | 46516-3683
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Country | US
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Telephone | 574-307-5502
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Fax | 866-598-4540
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Provider Business Mailing Address
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Address Line | 234 WATERFALL DR STE C
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City | ELKHART
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State | IN
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Zip | 46516-3683
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Country | US
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Telephone | 574-307-5502
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TALHIA YAJAIRA JUAREZ-AGUILAR
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Credential | DNP
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Telephone | 574-307-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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