MEDICARE: AWONG LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801608443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWONG LLC

Provider Business Mailing Address
First Line	:	5741 W 20TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2661
Country	:	US
Telephone Number	:	786-626-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 W 20TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2661
Country	:	US
Telephone Number	:	786-626-4106
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ANTHONY WONG PENA
Credential	:	CBHCMS
Telephone Number	:	786-626-4106

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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Directions to “AWONG LLC ” Practice Location

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