Basic Information
| Provider Information | |||||||||
| NPI: | 1417343260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASTORGA | ||||||||
| FirstName: | SUNANTA | ||||||||
| MiddleName: | ANGELA | ||||||||
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| Credential: | LBA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16782 VON KARMAN AVE STE 11 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926062417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195506368 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10015 LAKEWOOD DR SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533580888 | ||||||||
| FaxNumber: | 8554901545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 103K00000X | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 2108578 | 05 | WA | MEDICAID |