Healthcare Provider Details

I. General information

NPI: 1295028686
Provider Name (Legal Business Name): 4040I.COM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S DALE MABRY HIGHWAY SUITE 110
TAMPA FL
33609
US

IV. Provider business mailing address

405 S DALE MABRY HIGHWAY SUITE 110
TAMPA FL
33609
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9626
  • Fax: 630-723-0077
Mailing address:
  • Phone: 888-880-9626
  • Fax: 630-723-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: JOSE GONZALEZ
Title or Position: CEO
Credential:
Phone: 877-814-4040