Healthcare Provider Details

I. General information

NPI: 1306653407
Provider Name (Legal Business Name): ANTHONY PAUL SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 04/28/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD STE 3
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

9890 COUNTY FARM RD STE 3
RIVERSIDE CA
92503-3678
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8320
  • Fax:
Mailing address:
  • Phone: 951-509-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-GXNDIZ
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: