Healthcare Provider Details

I. General information

NPI: 1205617404
Provider Name (Legal Business Name): ELEMENTAL LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ALMERIA AVE STE 250
CORAL GABLES FL
33134-5835
US

IV. Provider business mailing address

299 ALHAMBRA CIR STE 315
CORAL GABLES FL
33134-5113
US

V. Phone/Fax

Practice location:
  • Phone: 954-231-5484
  • Fax: 239-379-4385
Mailing address:
  • Phone: 786-432-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ABBEY HERNANDEZ IKE
Title or Position: CEO
Credential: DC
Phone: 714-326-7647