Provider Demographics
NPI:1982014288
Name:SU-LE, ATHENA
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:SU-LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 W 182ND ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4402
Mailing Address - Country:US
Mailing Address - Phone:310-329-7777
Mailing Address - Fax:
Practice Address - Street 1:1836 W 182ND ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4402
Practice Address - Country:US
Practice Address - Phone:310-329-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982014288OtherNPPES