Provider Demographics
NPI:1528652419
Name:BAILEY, ATHENA
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:BAILEY
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 1:725 W AVENUE H4
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-1561
Mailing Address - Country:US
Mailing Address - Phone:661-878-6181
Mailing Address - Fax:
Practice Address - Street 1:40015 SIERRA HWY STREET
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7567
Practice Address - Country:US
Practice Address - Phone:661-878-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker