Provider Demographics
NPI:1417343260
Name:ASTORGA, SUNANTA ANGELA (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:SUNANTA
Middle Name:ANGELA
Last Name:ASTORGA
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:619-550-6368
Mailing Address - Fax:
Practice Address - Street 1:10015 LAKEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3838
Practice Address - Country:US
Practice Address - Phone:253-358-0888
Practice Address - Fax:855-490-1545
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2108578Medicaid