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General NPI Number Information
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NPI Number | 1083004287
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Entity Type | Organization
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Legal Business Name | ATHENA HEALTH CARE CENTER INC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 4240 LAKELAND HIGHLANDS RD
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City | LAKELAND
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State | FL
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Zip | 33813-3113
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Country | US
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Telephone | 863-646-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 5714 VINTAGE VIEW BLVD
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City | LAKELAND
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State | FL
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Zip | 33812-5067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMAURY GUERRA GUTIERREZ
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Credential | M.D.
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Telephone | 305-742-5026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME115832
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License Number State | FL
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