Provider Demographics
NPI:1497105381
Name:ELEMENTAL LLC
Entity Type:Organization
Organization Name:ELEMENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:281-653-2924
Mailing Address - Street 1:12436 FM 1960 RD W
Mailing Address - Street 2:SUITE 171
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4809
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:12436 FM 1960 RD W
Practice Address - Street 2:SUITE 171
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4809
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty