Provider Demographics
NPI:1306371927
Name:DR. JENNIFER BAUZA, PA
Entity Type:Organization
Organization Name:DR. JENNIFER BAUZA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BAUZA
Authorized Official - Last Name:PAJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-3338
Mailing Address - Street 1:8890 NW 78TH CT APT 342
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8220 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4002
Practice Address - Country:US
Practice Address - Phone:561-487-3340
Practice Address - Fax:561-488-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty