Healthcare Provider Details

I. General information

NPI: 1578320198
Provider Name (Legal Business Name): ELEMENT HOLDINGS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 S ORANGE BLOSSOM TRL STE 161
ORLANDO FL
32809-4677
US

IV. Provider business mailing address

6565 CYRILS DR
SAINT CLOUD FL
34771-8957
US

V. Phone/Fax

Practice location:
  • Phone: 407-401-8094
  • Fax:
Mailing address:
  • Phone: 407-401-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN CARLOS JOSE CRUZ-GONZALEZ
Title or Position: CEO
Credential:
Phone: 407-401-8094