Provider Demographics
NPI:1396802021
Name:ANDERSEN, ATHENA ELIZABETH (MD)
Entity type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:ELIZABETH
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3223
Mailing Address - Country:US
Mailing Address - Phone:714-628-3280
Mailing Address - Fax:714-633-4883
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-288-3230
Practice Address - Fax:714-744-5294
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine