Active Life Wound Center A Professional Medical Corporation
NPI 1396553616ActiveOrganization· Family Medicine· Sacramento, CA
Family Medicine in Sacramento, California, registered in NPPES in December 2024. The authorized official on file is Jeffrey Souza, Compliance Manager.
Overview
| NPI | 1396553616 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 19, 2024 |
| Last updated in NPPES | Dec 19, 2024 |
| Certified by provider | Dec 19, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
| Registered Nurse, Wound Care | 163WW0000X | — | — |
| Dermatology | 207N00000X | — | — |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
| Nurse Practitioner | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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