Individual
AMITHA BENA OMONUWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
708 DEL PRADO BLVD S STE 3, CAPE CORAL, FL 33990-2676
(239) 343-9960
(239) 424-4006
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9960
(239) 424-4006
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9109689
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01348305
AMERIGROUP
GA
05
—
019421700
—
FL
05
—
354613564A
—
GA
05
—
354613564B
—
GA
01
—
551847
WELLCARE
GA
Enumeration date
02/23/2010
Last updated
03/29/2021
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