Provider Demographics
NPI:1376141440
Name:AVANT GARDE PSYCHOLOGY INC
Entity type:Organization
Organization Name:AVANT GARDE PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:VALERE
Authorized Official - Last Name:ESTONACTOC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-412-7178
Mailing Address - Street 1:28292 EL SUR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4422
Mailing Address - Country:US
Mailing Address - Phone:949-412-7178
Mailing Address - Fax:
Practice Address - Street 1:2737 E COAST HWY STE F
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2110
Practice Address - Country:US
Practice Address - Phone:949-412-7178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty