Healthcare Provider Details

I. General information

NPI: 1497117683
Provider Name (Legal Business Name): PROACTIVE HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 E 4TH AVE
HIALEAH FL
33010-2714
US

IV. Provider business mailing address

1982 E 4TH AVE
HIALEAH FL
33010-2714
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-3231
  • Fax:
Mailing address:
  • Phone: 786-409-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14278
License Number State

VIII. Authorized Official

Name: LIUVA CRUZ DUQUE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 786-389-7598