Provider Demographics
NPI:1760704134
Name:BOCA FAMILY PRACTICE
Entity Type:Organization
Organization Name:BOCA FAMILY PRACTICE
Other - Org Name:BOCA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-812-1000
Mailing Address - Street 1:7100 CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-391-6552
Mailing Address - Fax:561-391-6285
Practice Address - Street 1:7100 CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-391-6552
Practice Address - Fax:561-391-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty