Provider Demographics
NPI:1952627176
Name:MOHEBBI, ATHENA X (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:X
Last Name:MOHEBBI
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 CAMINO DEL RIO S STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4033
Mailing Address - Country:US
Mailing Address - Phone:619-640-5555
Mailing Address - Fax:
Practice Address - Street 1:3703 CAMINO DEL RIO S STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4033
Practice Address - Country:US
Practice Address - Phone:619-640-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19120363L00000X
CA553787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily