Provider Demographics
NPI:1285347922
Name:ACTIVE FAMILY HEALTH, PLC
Entity type:Organization
Organization Name:ACTIVE FAMILY HEALTH, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-295-5345
Mailing Address - Street 1:27555 YNEZ RD STE 210
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4678
Mailing Address - Country:US
Mailing Address - Phone:949-295-5345
Mailing Address - Fax:949-326-7500
Practice Address - Street 1:27555 YNEZ RD STE 210
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4678
Practice Address - Country:US
Practice Address - Phone:949-295-5345
Practice Address - Fax:949-326-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty