Provider Demographics
NPI:1205569407
Name:BOZA, CESAR ANTONIO
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:ANTONIO
Last Name:BOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-1452
Mailing Address - Country:US
Mailing Address - Phone:850-300-2787
Mailing Address - Fax:
Practice Address - Street 1:5753 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-1452
Practice Address - Country:US
Practice Address - Phone:850-300-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program