Healthcare Provider Details

I. General information

NPI: 1932657194
Provider Name (Legal Business Name): LUCAS RAY SIMONITCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 EAST ST STE B
REDDING CA
96001-0834
US

IV. Provider business mailing address

991 W MOONLIGHT DR
ROBINSON TX
76706-7135
US

V. Phone/Fax

Practice location:
  • Phone: 530-395-2610
  • Fax:
Mailing address:
  • Phone: 214-535-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13087
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: