# ATHENA MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992313472
- **Authorized official:** BRYAN ALZATE (CEO)
- **Authorized official phone:** (954) 314-8202

## Contact information

- **Practice address:** 45 W 17TH ST, RIVIERA BEACH, FL 33404-6121
- **Practice address phone:** (954) 314-8202
- **Practice address fax:** (954) 842-4347
- **Mailing address:** 9050 PINES BLVD STE 460, PEMBROKE PINES, FL 33024-6402
- **Mailing address phone:** (954) 314-8202
- **Mailing address fax:** (954) 842-4347

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/21/2020
- **Last updated:** 12/17/2020