Provider Demographics
NPI:1669603445
Name:PENUELAS, ANTONIO NEVAREZ JR
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:NEVAREZ
Last Name:PENUELAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221433
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-8433
Mailing Address - Country:US
Mailing Address - Phone:916-207-2315
Mailing Address - Fax:866-379-0937
Practice Address - Street 1:120 WEST CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-740-4555
Practice Address - Fax:805-740-4558
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor