MEDICARE: ATHENA MAUGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1801431770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA MAUGA

Provider Business Mailing Address
First Line	:	4652 S 2080 W
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-5446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8783 S 2240 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9363
Country	:	US
Telephone Number	:	801-432-7986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ ATHENA MAUGA ” Practice Location

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