Provider Demographics
NPI:1619761772
Name:SIMANEK, THOMAS L
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:SIMANEK
Suffix:
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 1:13069 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-5538
Mailing Address - Country:US
Mailing Address - Phone:909-556-1599
Mailing Address - Fax:
Practice Address - Street 1:13069 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-5538
Practice Address - Country:US
Practice Address - Phone:909-556-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool