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General NPI Number Information
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NPI Number | 1205617404
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Entity Type | Organization
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Legal Business Name | ELEMENTAL LIVING INC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 301 ALMERIA AVE STE 250
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City | CORAL GABLES
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State | FL
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Zip | 33134-5835
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Country | US
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Telephone | 954-231-5484
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Fax | 239-379-4385
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Provider Business Mailing Address
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Address Line | 299 ALHAMBRA CIR STE 315
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City | CORAL GABLES
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State | FL
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Zip | 33134-5113
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Country | US
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Telephone | 786-432-1512
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ABBEY HERNANDEZ IKE
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Credential | DC
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Telephone | 714-326-7647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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