Healthcare Provider Details

I. General information

NPI: 1255164604
Provider Name (Legal Business Name): ATHENA HEALTH PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 FORMOSA WAY
PERRIS CA
92571-5119
US

IV. Provider business mailing address

5117 E TANGO CIR
ANAHEIM CA
92807-1206
US

V. Phone/Fax

Practice location:
  • Phone: 213-840-7660
  • Fax:
Mailing address:
  • Phone: 213-840-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DANNA LYN SANTIAGO
Title or Position: CFO
Credential:
Phone: 213-840-7660