Provider Demographics
NPI:1699523340
Name:AWA PRIMARY CARE PLLC
Entity type:Organization
Organization Name:AWA PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARILMA
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:WONG ARJONA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:407-579-1616
Mailing Address - Street 1:200 N PALM AVE UNIT 33451
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-5019
Mailing Address - Country:US
Mailing Address - Phone:407-579-1616
Mailing Address - Fax:833-450-4891
Practice Address - Street 1:97 NIEMIRA AVE APT E
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-2936
Practice Address - Country:US
Practice Address - Phone:407-579-1616
Practice Address - Fax:855-642-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care