Healthcare Provider Details

I. General information

NPI: 1225956287
Provider Name (Legal Business Name): HOLLY DENISE SIMENTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3192 GLEN CANYON RD
SCOTTS VALLEY CA
95066-4916
US

IV. Provider business mailing address

14240 CHAMY DR
RENO NV
89521-7362
US

V. Phone/Fax

Practice location:
  • Phone: 831-438-1868
  • Fax:
Mailing address:
  • Phone: 831-438-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95433710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: