=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447680228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATHENA HEALTH GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2013
-----------------------------------------------------
Last Update Date | 11/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 685 KM 1.9 BO. TIERRAS NUEVAS
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-6999
-----------------------------------------------------
Fax | 787-854-6966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1019
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-6999
-----------------------------------------------------
Fax | 787-854-6966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VICTOR J VENEGAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-346-0331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------