Healthcare Provider Details

I. General information

NPI: 1205569407
Provider Name (Legal Business Name): CESAR ANTONIO BOZA GAITAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VONDERBURG DR STE 102
BRANDON FL
33511-5968
US

IV. Provider business mailing address

500 VONDERBURG DR STE 102
BRANDON FL
33511-5968
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5658
  • Fax: 813-681-5250
Mailing address:
  • Phone: 813-681-5658
  • Fax: 813-681-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME183058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: