Provider Demographics
NPI:1720744881
Name:BONZA HEALTH
Entity Type:Organization
Organization Name:BONZA HEALTH
Other - Org Name:BONZA WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BONZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:614-813-0764
Mailing Address - Street 1:3360 TREMONT RD STE 240
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2111
Mailing Address - Country:US
Mailing Address - Phone:614-829-8888
Mailing Address - Fax:614-881-1792
Practice Address - Street 1:3360 TREMONT RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2111
Practice Address - Country:US
Practice Address - Phone:614-829-8888
Practice Address - Fax:614-881-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1487694709Medicaid