Provider Demographics
NPI:1194364968
Name:SIMENTAL, ANTONIO (ASW)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SIMENTAL
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 E DEERE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5718
Mailing Address - Country:US
Mailing Address - Phone:949-697-6885
Mailing Address - Fax:
Practice Address - Street 1:6891 MAGNOLIA AVE APT B
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3777
Practice Address - Country:US
Practice Address - Phone:714-853-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA958461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical