Provider Demographics
NPI:1205617404
Name:ELEMENTAL LIVING INC
Entity type:Organization
Organization Name:ELEMENTAL LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ IKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-326-7647
Mailing Address - Street 1:299 ALHAMBRA CIR STE 315
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5113
Mailing Address - Country:US
Mailing Address - Phone:786-432-1512
Mailing Address - Fax:
Practice Address - Street 1:301 ALMERIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5835
Practice Address - Country:US
Practice Address - Phone:954-231-5484
Practice Address - Fax:239-379-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty