Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
363LP2300X | 50 | Nurse Practitioner |
| NPI Number | 1609680776 |
| LBN Legal business name | ACTIVA MEDICAL CENTER & SPA |
| Authorized official | AIMEE GONZALEZ - (FAMILY NURSE PRACTITIONER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 02/06/2025 |
| Last updated | 02/06/2025 - More than a year ago |
| Identifiers | n/a |
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