Provider Demographics
NPI:1164605408
Name:BOZENA B SABALA DO PA
Entity Type:Organization
Organization Name:BOZENA B SABALA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOZENA
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:SABALA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-443-3832
Mailing Address - Street 1:2014 DREW ST
Mailing Address - Street 2:STE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3100
Mailing Address - Country:US
Mailing Address - Phone:727-443-3832
Mailing Address - Fax:727-443-7903
Practice Address - Street 1:2014 DREW ST
Practice Address - Street 2:STE 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3100
Practice Address - Country:US
Practice Address - Phone:727-443-3832
Practice Address - Fax:727-443-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI10985Medicare UPIN
FLK5992Medicare PIN