Healthcare Provider Details

I. General information

NPI: 1316510506
Provider Name (Legal Business Name): PROACTIVE HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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