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KISSIMMEE PRIMARY CARE ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA
NPI 1396925574
Family Medicine - Adult Medicine in Kissimmee, FL

Active since November 06, 2007CLIA 10D1050572 · Waiver
1520 N JOHN YOUNG PKWY, KISSIMMEE, FL 34741(407) 518-7700(407) 518-7100 Get Directions Write a Review

NPPES record last updated: February 16, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kissimmee Primary Care Anti-aging Wellness And Weight Loss Center Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KISSIMMEE PRIMARY CARE ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA (NPI 1396925574) is a healthcare organization registered as an adult medicine in Kissimmee, Florida and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through February 6, 2028 and lists Mohamed H Gajraj, President, as its authorized official.

NPPES Registry Identity

NPI1396925574
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameKISSIMMEE PRIMARY CARE ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA
Location Address1520 N JOHN YOUNG PKWYKissimmee, FL 34741-3219
Mailing Address1520 N John Young PkwyKissimmee, FL 34741-3219 · (407) 518-7700 · Fax (407) 518-7100
Phone(407) 518-7700
Fax(407) 518-7100
Organization SubpartNo
Authorized OfficialMohamed H GajrajPresident · (407) 518-7700
Enumeration DateNovember 6, 2007
Last NPPES UpdateFebruary 16, 2009
✔ NPI 1396925574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
1520 N JOHN YOUNG PKWY, Kissimmee, FL 34741
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Other Identifiers 1

Medicare PINAN988FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1050572

Kissimmee Primary Care · Kissimmee, FL
Active · expires Feb 6, 2028
CLIA Number10D1050572
Laboratory TypePhysician Office
Certificate Effective DateFebruary 7, 2026
Certificate Expiration DateFebruary 6, 2028
Laboratory DirectorAisha Idrees
Laboratory Phone(407) 518-7700
Laboratory LocationKissimmee Primary Care1520 John Young Pkwy, Kissimmee, FL 34741
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FLORIDA INJURY AND REHAB
Clinic/Center (Rehabilitation)
1520 N JOHN YOUNG PKWY
KISSIMMEE, FL 34741
Osceola County (407) 518-7700
DR. SAEED AHMAD M.D.
Family Medicine
1520 N JOHN YOUNG PKWY
KISSIMMEE, FL 34741
Osceola County (407) 518-7700
KISSIMMEE PRIMARY CARE ANTI-AGING WELLNESS AND WEIGHTLOSS CENTER PA
Internal Medicine
1520 N JOHN YOUNG PKWY
KISSIMMEE, FL 34741
Osceola County (407) 518-7700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA's NPI number?

The NPI number for Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA is 1396925574. It was assigned to this organization in the NPPES registry on November 6, 2007.

Where is Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA located?

Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA is located at 1520 N John Young Pkwy, Kissimmee, FL 34741. The listed phone number is (407) 518-7700.

What is Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Does Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1050572) is associated with this NPI, valid through February 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kissimmee Primary Care Anti-Aging Wellness And Weight Loss Center PA was last updated on February 16, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.