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General NPI Number Information
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NPI Number | 1275053712
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Entity Type | Individual
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Provider Name | ATHENA MIKROS MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-1098
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Country | US
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Telephone | 619-532-6400
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 475 BOX 1375
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City | FPO
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State | AP
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Zip | 96350-1375
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2021-0311
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License Number State | NC
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