Provider Demographics
NPI:1053120626
Name:ATEGA, MYLA TRIXIA MANDAYA
Entity type:Individual
Prefix:MRS
First Name:MYLA TRIXIA
Middle Name:MANDAYA
Last Name:ATEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MYLA TRIXIA
Other - Middle Name:MANDAYA
Other - Last Name:ATEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:7000 MICHAEL CANLIS WAY
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9781
Mailing Address - Country:US
Mailing Address - Phone:209-468-4787
Mailing Address - Fax:
Practice Address - Street 1:7000 MICHAEL CANLIS WAY
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9781
Practice Address - Country:US
Practice Address - Phone:209-468-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42755167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician