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General NPI Number Information
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NPI Number | 1952797573
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Entity Type | Organization
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Legal Business Name | FOREVER HEALTHY LIVING INC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 3934 SW 8TH ST STE 308
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City | CORAL GABLES
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State | FL
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Zip | 33134-2949
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Country | US
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Telephone | 305-793-8195
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Fax |
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Provider Business Mailing Address
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Address Line | 3934 SW 8TH ST STE 308
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City | CORAL GABLES
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State | FL
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Zip | 33134-2949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAGOBERTO NAVIA LA ROSA
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Credential | LMT
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Telephone | 305-793-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME65756
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT1567
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME65756
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License Number State | FL
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