Provider Demographics
NPI:1083389191
Name:REED, ATHENA ELAINE
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:ELAINE
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ATHENA
Other - Middle Name:ELAINE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:THE 800 J STREET
Mailing Address - Street 2:UNIT 528
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2521
Mailing Address - Country:US
Mailing Address - Phone:916-617-0039
Mailing Address - Fax:
Practice Address - Street 1:THE 800 J STREET
Practice Address - Street 2:UNIT 528
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2521
Practice Address - Country:US
Practice Address - Phone:916-617-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4162836172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver