Provider Demographics
NPI:1992120703
Name:REMENTEGUI, ANASTASIA CORNELLIA (BS/ MS INTERN MFT)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:CORNELLIA
Last Name:REMENTEGUI
Suffix:
Gender:F
Credentials:BS/ MS INTERN MFT
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:CORNELLIA
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-8098
Mailing Address - Fax:661-868-1841
Practice Address - Street 1:2151 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4113
Practice Address - Country:US
Practice Address - Phone:661-868-1890
Practice Address - Fax:661-868-1841
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96793101Y00000X
CA617771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPIKCMHARMedicaid