Provider Demographics
NPI:1558411652
Name:ASTALIS, PAULA MICHELE (PHD)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MICHELE
Last Name:ASTALIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 LONE TREE WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6015
Mailing Address - Country:US
Mailing Address - Phone:925-350-0906
Mailing Address - Fax:707-222-4342
Practice Address - Street 1:3701 LONE TREE WAY STE 5
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-350-0906
Practice Address - Fax:707-222-4342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21364103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist