Provider Demographics
NPI:1902468077
Name:AKL ACTIVE INC
Entity type:Organization
Organization Name:AKL ACTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-290-0622
Mailing Address - Street 1:1712 N RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3409
Mailing Address - Country:US
Mailing Address - Phone:407-272-8813
Mailing Address - Fax:866-802-2363
Practice Address - Street 1:1767 SPICEBUSH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6847
Practice Address - Country:US
Practice Address - Phone:407-272-8813
Practice Address - Fax:866-802-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center