MEDICARE: PROACTIVE HEALTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA14278
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497117683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE HEALTH CORP

Provider Business Mailing Address
First Line	:	1982 E 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2714
Country	:	US
Telephone Number	:	786-409-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1982 E 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2714
Country	:	US
Telephone Number	:	786-409-3231
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LIUVA CRUZ DUQUE
Credential	:
Telephone Number	:	786-389-7598

Provider Enumeration Date	:	03/25/2016
Last Update Date	:	02/19/2026

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Directions to “PROACTIVE HEALTH CORP ” Practice Location

Language	Start Address	Practice Location

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