Provider Demographics
NPI:1184258436
Name:ELEMENTAL TELEHEALTH, INC
Entity type:Organization
Organization Name:ELEMENTAL TELEHEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-594-6548
Mailing Address - Street 1:3030 BRIDGEWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY STE 101
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2810
Practice Address - Country:US
Practice Address - Phone:626-594-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service