Provider Demographics
NPI:1750796827
Name:PROACTIVE HEALTH LABS, INC.
Entity type:Organization
Organization Name:PROACTIVE HEALTH LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-406-0503
Mailing Address - Street 1:303 N GLENOAKS BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1147
Mailing Address - Country:US
Mailing Address - Phone:818-556-3844
Mailing Address - Fax:
Practice Address - Street 1:1241 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1468
Practice Address - Country:US
Practice Address - Phone:818-556-3844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center