Provider Demographics
NPI:1295028686
Name:4040I.COM INC
Entity Type:Organization
Organization Name:4040I.COM INC
Other - Org Name:4040I PRO HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-814-4040
Mailing Address - Street 1:405 S DALE MABRY HIGHWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:888-880-9626
Mailing Address - Fax:630-723-0077
Practice Address - Street 1:405 S DALE MABRY HIGHWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:888-880-9626
Practice Address - Fax:630-723-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty