Healthcare Provider Details

I. General information

NPI: 1467886549
Provider Name (Legal Business Name): HEALTHY LIVING MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE SUITE 404
PASADENA CA
91105-2561
US

IV. Provider business mailing address

301 S FAIR OAKS AVE SUITE 404
PASADENA CA
91105-2561
US

V. Phone/Fax

Practice location:
  • Phone: 626-716-9206
  • Fax:
Mailing address:
  • Phone: 626-716-9206
  • Fax: 626-709-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberCA55905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA ALEXANDER JACOBI
Title or Position: PRESIDENT
Credential: MD
Phone: 626-716-9206