Healthcare Provider Details

I. General information

NPI: 1831122316
Provider Name (Legal Business Name): ATHENA MEDICAL CENTER FOR WOMEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 CHERRY LN
MANTECA CA
95337-4355
US

IV. Provider business mailing address

321 CHERRY LN
MANTECA CA
95337-4355
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-5484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA40262
License Number StateCA

VIII. Authorized Official

Name: AUTHER E ADAMS
Title or Position: MD
Credential:
Phone: 209-825-5484