Healthcare Provider Details

I. General information

NPI: 1669349957
Provider Name (Legal Business Name): EMBODY ELECTROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 2ND ST STE 100
SANTA MONICA CA
90401-4104
US

IV. Provider business mailing address

1333 2ND ST STE 100
SANTA MONICA CA
90401-4104
US

V. Phone/Fax

Practice location:
  • Phone: 323-608-6910
  • Fax:
Mailing address:
  • Phone: 323-608-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAI ABE
Title or Position: OWNER
Credential:
Phone: 424-466-9656