=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245017854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I AM I AM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2023
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3985 DARBY LN
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-426-0426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3985 DARBY LN
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-426-0426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNP/OWNER
-----------------------------------------------------
Name | ELENA GONZALEZ
-----------------------------------------------------
Credential | CNP
-----------------------------------------------------
Telephone | 877-426-0426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------