Healthcare Provider Details

I. General information

NPI: 1134215981
Provider Name (Legal Business Name): STAR QUALITY HEALTH GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14508 N 18TH ST
TAMPA FL
33613-2416
US

IV. Provider business mailing address

14508 N 18TH ST
TAMPA FL
33613-2416
US

V. Phone/Fax

Practice location:
  • Phone: 813-631-0599
  • Fax: 813-632-6606
Mailing address:
  • Phone: 813-631-0599
  • Fax: 813-632-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MS. NELLIE VASQUEZ MOSLEY
Title or Position: BUSINESS OWNER
Credential:
Phone: 813-631-0599