Provider Demographics
NPI:1669349957
Name:EMBODY ELECTROLOGY
Entity type:Organization
Organization Name:EMBODY ELECTROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-466-9656
Mailing Address - Street 1:1333 2ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-4104
Mailing Address - Country:US
Mailing Address - Phone:323-608-6910
Mailing Address - Fax:
Practice Address - Street 1:1333 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-4104
Practice Address - Country:US
Practice Address - Phone:323-608-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service