Provider Demographics
NPI:1952797573
Name:FOREVER HEALTHY LIVING INC
Entity Type:Organization
Organization Name:FOREVER HEALTHY LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVIA LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-793-8195
Mailing Address - Street 1:3934 SW 8TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3934 SW 8TH ST STE 308
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:305-793-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65756207Q00000X, 261QM2500X
FLPT1567208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty