Provider Demographics
NPI:1578799854
Name:ACTIVEMED INTEGRATIVE HEALTH CENTER
Entity Type:Organization
Organization Name:ACTIVEMED INTEGRATIVE HEALTH CENTER
Other - Org Name:NCIAC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:858-673-4400
Mailing Address - Street 1:15611 POMERADO RD # 100SW
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-673-4400
Mailing Address - Fax:
Practice Address - Street 1:317 N EL CAMINO REAL STE 306
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2814
Practice Address - Country:US
Practice Address - Phone:858-673-4400
Practice Address - Fax:858-673-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty