Provider Demographics
NPI:1558156042
Name:FIVE ELEMENTS SPA LLC
Entity type:Organization
Organization Name:FIVE ELEMENTS SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:USTAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:267-934-4456
Mailing Address - Street 1:1680 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4419
Mailing Address - Country:US
Mailing Address - Phone:954-531-0070
Mailing Address - Fax:
Practice Address - Street 1:1680 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4419
Practice Address - Country:US
Practice Address - Phone:954-531-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center