Provider Demographics
NPI:1033532668
Name:HEALTHY LIVING INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON/MD
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ MORAYTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-285-0065
Mailing Address - Street 1:9221 SW BARBUR BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5408
Mailing Address - Country:US
Mailing Address - Phone:971-285-0065
Mailing Address - Fax:888-977-1630
Practice Address - Street 1:9221 SW BARBUR BLVD
Practice Address - Street 2:STE 208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5408
Practice Address - Country:US
Practice Address - Phone:971-285-0065
Practice Address - Fax:888-977-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165430261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care