Provider Demographics
NPI:1235348293
Name:ATHENA PROSTHETIC SERVICES INCORPORATED
Entity Type:Organization
Organization Name:ATHENA PROSTHETIC SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:626-256-6360
Mailing Address - Street 1:2824 FAIRGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5522
Mailing Address - Country:US
Mailing Address - Phone:626-256-6360
Mailing Address - Fax:
Practice Address - Street 1:2824 FAIRGREEN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5522
Practice Address - Country:US
Practice Address - Phone:626-256-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1246300001Medicare ID - Type Unspecified