Healthcare Provider Details

I. General information

NPI: 1740938349
Provider Name (Legal Business Name): C4, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 THOMAS LAKE HARRIS DR UNIT 311
SANTA ROSA CA
95403-0195
US

IV. Provider business mailing address

4623 THOMAS LAKE HARRIS DR UNIT 311
SANTA ROSA CA
95403-0195
US

V. Phone/Fax

Practice location:
  • Phone: 402-517-2446
  • Fax:
Mailing address:
  • Phone: 402-517-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAULIN UPENDRA VORA
Title or Position: PRESIDENT
Credential: MD
Phone: 402-517-2446